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Systematic Reviews and American College of Physicians Clinical Practice Guidelines

Systematic Reviews and American College of Physicians Clinical Practice Guidelines. Amir Qaseem , MD, PhD, MHA, FACP Director, Clinical Policy American College of Physicians. Who We Are. Largest medical specialty organization in the US 132,000 members Internists

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Systematic Reviews and American College of Physicians Clinical Practice Guidelines

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  1. Systematic Reviews and American College of Physicians Clinical Practice Guidelines Amir Qaseem, MD, PhD, MHA, FACP Director, Clinical Policy American College of Physicians

  2. Who We Are • Largest medical specialty organization in the US • 132,000 members • Internists • Internal Medicine sub-specialists • Residents/fellows training in Internal Medicine or its subspecialties • Medical students • Headquarters in Philadelphia and an office in Washington, D.C.

  3. History of ACP Clinical Guidelines • Program was established in 1981 • Developed by Clinical Guidelines Committee • Screening, Dx, and Rx to help clinicians in making health care decisions

  4. ACP’s Guidelines Coverage • Top 3 most valued product • Most common reason to visit ACP’s website • 25 of the top 100 most read articles ever in the Annals of Internal Medicine • Top most read article in Internal Medicine on Medscape • All ACP Guidelines are regularly covered by print, TV, radio, and online stories

  5. ACP Guidelines Coverage

  6. ACP and Systematic Reviews • Clinical Policies • Clinical Guidelines • Guidance Statements • High-Value Cost Conscious Care Advice • Performance measurement • Gaps

  7. ACP Membership Feedback • High quality guidelines • Based on scientific evidence • Helpful source of advice • Not rigid or difficult to apply • Not difficult to understand or use

  8. The need for a good systematic review? • Medical literature is expanding at an extremely fast rate • RCTs in MEDLINE (5,000 per yr from 1978-1985 to 25,000 per year in 1994-2001) • 15 million citations on MEDLINE and 10,000-20,000 added per week • Evidence → Clinical Guidelines

  9. ACP and Systematic Reviews • Systematic Reviews • ACP sponsored • Collaboration with other societies • AHRQ’s Evidence-based Practice Centers • Working together since1999 • EPC & EHC • 66% of our guidelines based on EPC evidence reports • Available Systematic Reviews

  10. Issues with Systematic Reviews • Major variation in quality • COI • Multidisciplinary • Scope not clearly defined or followed • Key Questions not well-formulated

  11. Issues with Systematic Reviews • Poor methods or poorly documented methods • Lack of a standard reporting system • Lack of a grading system • Do not address all outcomes

  12. Relationship between Guideline Developers & Systematic Review Developers • What is the purpose of a SR? • Balance inappropriate influence with critical input • Develop a line of communication with guideline group • Include a rep in TEP • Responsiveness to the questions of guideline group

  13. Relationship between Guideline Developers & Systematic Review Developers • Registry of systematic reviews • GINDER (Guidelines International Network) • PROSPERO (National Institute for Health Research)

  14. Clinical Practice Guidelines “Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options”

  15. Summary • SR are the backbone of a guideline • A good and well-developed SR is costly, resource intensive, and time consuming • Some of us underestimate the resources and expertise needed and the result is variability in quality of SRs • A good SR is a collaborative effort and guideline developers should be able to provide their expertise among the contributors

  16. Questions

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