This article summarizes two randomly-selected clinical guidelines and juxtaposes each in a tabular format to the 23-point rubric published by the Appraisal of Guidelines for Research & Evaluation (AGREE) organization. Both guidelines are searchable in ontology-type categories relative to the audience they pertain to (e.g., age ranges, bodily systems, etc.). There is no sorting-type mechanism that would allow providers to find the relevant portion of the guidelines sought after out of the dozens of pages of each “guideline.”
In both cases, the National Guideline Clearinghouse maintained by the US Department of Health and Human Services was found to be vastly inferior to using the commercial service UpToDate, largely because of the frequency of updating. A cursory review of the guidelines in the US Government clearinghouse indicated many guidelines were more than several years old. In a 2014 study published in the journal CMAJ evaluating the survival validity (e.g., how long guidelines were valid without updating) found that 5% of guidelines were invalid in one year, 14% were invalid after two years, 19% were invalid after three years, and 22% were invalid after four years. (Laura Martínez García, 2014) In other words, a significant portion, if not a majority, of the clinical guidelines being propagated by the US Department of Health & Human Services are now invalid and may actually harm, not help, patients. Conversely, UpToDate has hundreds of thousands of researchers and physicians peer-reviewing entries frequently to ensure it is “up to date.”
The clinical guideline for the treatment of chronic hepatitis B (NGC: 010903) is a 45-page standard written by the American Association for the Study of Liver Diseases in January 2016. This clinical standard follows a format that is similar upon first impression, but different in quality of content, than the example for adult sinusitis. It begins with a general summary of treatment (e.g., specific anti-viral therapy medication combinations). It continues by differentiating recommended recovery treatments for adults if they are certain co-morbidities (e.g., viremia, pregnancy, etc.) or are non-responsive to first-line medications. It follows a format with a section for recommended algorithms (none), risk assessing, methodologies in its design (e.g., similar to study design methodologies), and a 15 outcome of treatment considerations. (American Association for the Study of Liver Diseases, 2017)
The clinical guideline for the treatment of adult sinusitis (NGC: 010703) is a 70-page standard written by the American Academy of Otolaryngology and Head and Neck Surgery Foundation in September 2007, and revised in April 2015. The standard is broken down into four sections to be performed in sequence: (1) differential diagnoses (e.g., acute bacterial rhinosinusitis (ABRS)); (2) symptomatic relief goals; (3) medication choice (e.g., amoxicillin); and, (4) recovery therapies (contingencies if primary treatment recommendations fail). While the sinusitis standard has the same categories of description as the standard for Hepatitis B, the answers are often perfunctory and lack much development or details. (American Academy of Otolaryngology - Head and Neck Surgery Foundation, 2017)
Works Cited
American Academy of Otolaryngology - Head and Neck Surgery Foundation. (2017, January 8). Clinical practice guideline (update): adult sinusitis. Retrieved from US DHHS: AHRQ National Guideline Clearninghouse: https://www.guideline.gov/summaries/summary/49207/clinical-practice-guideline-update-adult-sinusitis
American Association for the Study of Liver Diseases. (2017, January 8). AASLD guidelines for treatment of chronic hepatitis B. Retrieved from US DHHS: AHRQ - National Guideline Clearinghouse: https://www.guideline.gov/search?f_Clinical_Specialty=Infectious+Diseases&fLockTerm=Infectious+Diseases&f_Meets_Revised_Inclusion_Criteria=yes&page=1
Laura Martínez García, A. J. (2014). The validity of recommendations from clinical guidelines: a survival analysis. CMAJ, 1211–1219.
National Quality Forum. (2017, January 8). Abdominal Aortic Aneurysm (AAA) Repair Mortality Rate (IQI 11). Retrieved from National Quality Forum: http://www.qualityforum.org/QPS/QPSTool.aspx#qpsPageState=%7B%22TabType%22%3A1,%22TabContentType%22%3A2,%22SearchCriteriaForStandard%22%3A%7B%22TaxonomyIDs%22%3A%5B%2216%3A389%22%5D,%22SelectedTypeAheadFilterOption%22%3Anull,%22Keyword%22%3A%22%22,%22Page
NQF. (2017, January 8). Accidental Puncture or Laceration Rate (PDI #1). Retrieved from National Qualify Forum: http://www.qualityforum.org/QPS/QPSTool.aspx#qpsPageState=%7B%22TabType%22%3A1,%22TabContentType%22%3A2,%22SearchCriteriaForStandard%22%3A%7B%22TaxonomyIDs%22%3A%5B%2216%3A389%22%5D,%22SelectedTypeAheadFilterOption%22%3Anull,%22Keyword%22%3A%22%22,%22Page
No comments:
Post a Comment