Guideline for Guidelines
One of the most important advances the Academy has made to improve healthcare outcomes and fulfill its mission to empower physicians to provide the best healthcare has been the successful development and implementation of a process for creating relevant, valid, otolaryngology-specific evidence-based guidelines. Our published methodology, which has been cited by the Institute of Medicine (IOM) and the Council of Medical Specialty Societies (CMSS) in their work on guidelines, is just receiving its third revision and will be published this month as a supplement in our journal Otolaryngology–Head and Neck Surgery. The Academy first published its guideline methodology in the journal in October 2006, followed by an advanced and updated version in June 2009. Since the first issue, the Academy has been successfully building guidelines, applying them to quality improvement through performance measurement, and providing members and other practitioners with better tools to improve patient care. As Academy members and staff have presented at multi-disciplinary meetings on quality improvement, evidence-based medicine, and performance measures thoughout the years, we have frequently made copies of our methodology available to other specialties, international participants, and even allied health provider groups. Our approach was highly regarded and the number of copies was always insufficient to meet the demand. Over time, we have been complimented and cited for the principles contained therein that are essential to effective use of guidelines for improving care. In 2008, the U.S. Congress passed the Medicare Improvements for Patients and Providers Act (MIPPA), which required the IOM to undertake a study of guideline development and to make recommendations for better application of medical knowledge to improve patient care. The IOM committee’s work in response to the MIPPA was published in March of 2011, outlining eight standards for creating rigorous, trustworthy clinical practice guidelines (CPGs). The report, “Clinical Practice Guidelines We Can Trust,” called upon the Agency for Healthcare Research and Quality (AHRQ) to engage in demonstrations of the application of these standards to assess their validity and reliability. If you have not read it, at least a cursory review of these standards is important to understand the true value of guidelines—not as “cookbook medicine” or a prescriptive mandate for care; but as a useful tool for all physicians who daily face difficult decisions and uncertainty in their care of each patient. These standards can be found on the IOM’s website at www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust/Standards.aspx and a short summary of the development of the IOM report is at www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx. During the course of the committee’s deliberations, its chair, Sheldon Greenfield, MD, expressed to Norman Kahn, MD, CEO of the Council of Medical Specialty Societies, his hope that the CMSS would engage its member societies (which represent nearly 750,000 specialist physicians in the United States) in creating their own statement of best practices for implementing these standards so that all guidelines developed could be relied upon to represent the best available care recommendations. CMSS took this charge seriously and assigned the CPG Component Group, which it convened to draft a white paper that would serve as a guide on which societies could model their methodology for CPG development. After nearly 18 months of collaboration and work this “guideline for guidelines” was presented in November 2012, and approved by the Council. The Academy’s Board of Directors voted to support this document and recognized that it mirrors most of the carefully crafted elements of our published methodology. It is well worth noting that both the IOM and the CMSS received input and testimony during their work from otolaryngologists and both entities cited the Academy’s published methods in their reports. As you read Otolaryngology–Head and Neck Surgery this month, I urge every Academy member to read the supplement on guideline methodology and become familiar with the motivation behind, and the purpose for, developing and implementing guidelines. Reference to the appropriate uses of guidelines and their limitations is made within the document. Key elements, such as including multiple specialties and perspectives in guideline development, transparency, avoiding and managing conflicts of interest, articulating strength of recommendations, and extensive external review are all critical to achieving the goal of effectively using guidelines to apply the best available evidence to patient care and achieving the best outcomes. I extend my personal thanks to the tireless volunteers on our Guidelines Development Task Force, reviewing committees, specialty societies, and staff who have built such a strong culture of quality improvement.
David R. Nielsen, MD, AAO-HNS/F EVP/CEOOne of the most important advances the Academy has made to improve healthcare outcomes and fulfill its mission to empower physicians to provide the best healthcare has been the successful development and implementation of a process for creating relevant, valid, otolaryngology-specific evidence-based guidelines. Our published methodology, which has been cited by the Institute of Medicine (IOM) and the Council of Medical Specialty Societies (CMSS) in their work on guidelines, is just receiving its third revision and will be published this month as a supplement in our journal Otolaryngology–Head and Neck Surgery.
The Academy first published its guideline methodology in the journal in October 2006, followed by an advanced and updated version in June 2009. Since the first issue, the Academy has been successfully building guidelines, applying them to quality improvement through performance measurement, and providing members and other practitioners with better tools to improve patient care. As Academy members and staff have presented at multi-disciplinary meetings on quality improvement, evidence-based medicine, and performance measures thoughout the years, we have frequently made copies of our methodology available to other specialties, international participants, and even allied health provider groups. Our approach was highly regarded and the number of copies was always insufficient to meet the demand. Over time, we have been complimented and cited for the principles contained therein that are essential to effective use of guidelines for improving care.
In 2008, the U.S. Congress passed the Medicare Improvements for Patients and Providers Act (MIPPA), which required the IOM to undertake a study of guideline development and to make recommendations for better application of medical knowledge to improve patient care. The IOM committee’s work in response to the MIPPA was published in March of 2011, outlining eight standards for creating rigorous, trustworthy clinical practice guidelines (CPGs). The report, “Clinical Practice Guidelines We Can Trust,” called upon the Agency for Healthcare Research and Quality (AHRQ) to engage in demonstrations of the application of these standards to assess their validity and reliability. If you have not read it, at least a cursory review of these standards is important to understand the true value of guidelines—not as “cookbook medicine” or a prescriptive mandate for care; but as a useful tool for all physicians who daily face difficult decisions and uncertainty in their care of each patient. These standards can be found on the IOM’s website at www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust/Standards.aspx and a short summary of the development of the IOM report is at www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx.
During the course of the committee’s deliberations, its chair, Sheldon Greenfield, MD, expressed to Norman Kahn, MD, CEO of the Council of Medical Specialty Societies, his hope that the CMSS would engage its member societies (which represent nearly 750,000 specialist physicians in the United States) in creating their own statement of best practices for implementing these standards so that all guidelines developed could be relied upon to represent the best available care recommendations. CMSS took this charge seriously and assigned the CPG Component Group, which it convened to draft a white paper that would serve as a guide on which societies could model their methodology for CPG development. After nearly 18 months of collaboration and work this “guideline for guidelines” was presented in November 2012, and approved by the Council. The Academy’s Board of Directors voted to support this document and recognized that it mirrors most of the carefully crafted elements of our published methodology. It is well worth noting that both the IOM and the CMSS received input and testimony during their work from otolaryngologists and both entities cited the Academy’s published methods in their reports.
As you read Otolaryngology–Head and Neck Surgery this month, I urge every Academy member to read the supplement on guideline methodology and become familiar with the motivation behind, and the purpose for, developing and implementing guidelines. Reference to the appropriate uses of guidelines and their limitations is made within the document. Key elements, such as including multiple specialties and perspectives in guideline development, transparency, avoiding and managing conflicts of interest, articulating strength of recommendations, and extensive external review are all critical to achieving the goal of effectively using guidelines to apply the best available evidence to patient care and achieving the best outcomes. I extend my personal thanks to the tireless volunteers on our Guidelines Development Task Force, reviewing committees, specialty societies, and staff who have built such a strong culture of quality improvement.
