Failure of Clinical Practice Guidelines to Meet Institute of Medicine Standards Two More Decades of Little, If Any, Progress
Failure of Clinical Practice Guidelines to Meet Institute of Medicine Standards Two More Decades of Little, If Any, Progress
复制标题
DOI：
10.1001/2013.jamainternmed.56
复制
发表时间：
2012-11-26
影响因子：
--
通讯作者：
Mackowiak, Philip A.
中科院分区：
文献类型：
--
作者：
Kung, Justin;Miller, Ram R.;Mackowiak, Philip A.
背景资料：2011年3月，美国医学研究所（IOM）发布了一套新的临床实践指南标准，旨在提高指南的质量。据我们所知，没有系统的审查，坚持这样的标准已经进行了，因为一个超过十年前published.Methods：两个审查员独立筛选130指南随机选择从国家指南交换所（NGC）网站符合18 25 IOM标准。结果：符合IOM标准的总体中位数（百分比）为8（44.4%）（共18项），四分位数范围为6.5（36.1%）至9.5（52.8%）。在接受调查的指南中，只有不到一半的指南符合IOM标准的50%以上。只有三分之一的亚专业协会制定的指南符合超过50%的IOM标准。在所调查的准则中，只有不到一半的准则提供了关于利益冲突的信息。在这些包括此类信息的指南中，超过三分之二的委员会主席（71.4%）和90.5%的共同主席都有COI。除了美国政府机构制定的指导方针外，很少描述选择委员会成员的标准和选择过程。制定指南的委员会很少包括信息科学家或患者或患者代表。在制定指南时很少考虑非英语文献、未发表的数据和/或摘要;委员会成员之间的意见分歧通常不会在指南中公布;推荐的益处比潜在危害更常见。从2006年到2011年出版的指南变化不大，平均IOM standards satisfied.Conclusion：作为2011年6月在NGC网站上存档的临床实践指南的随机样本的分析表明，符合IOM标准，很少，如果有任何改善，在过去的20年。
Background: In March 2011, the Institute of Medicine (IOM) issued a new set of standards for clinical practice guidelines intended to enhance the quality of guidelines being produced. To our knowledge, no systematic review of adherence to such standards has been under-taken since one published over a decade ago.Methods: Two reviewers independently screened 130 guidelines selected at random from the National Guideline Clearinghouse (NGC) website for compliance with 18 of 25 IOM standards.Results: The overall median number (percentage) of IOM standards satisfied (out of 18) was 8 (44.4%), with an interquartile range of 6.5 (36.1%) to 9.5 (52.8%). Fewer than half of the guidelines surveyed met more than 50% of the IOM standards. Barely a third of the guidelines produced by subspecialty societies satisfied more than 50% of the IOM standards surveyed. Information on conflicts of interest (COIs) was given in fewer than half of the guidelines surveyed. Of those guidelines including such information, COIs were present in over two-thirds of committee chairpersons (71.4%) and 90.5% of cochairpersons. Except for US government agency-produced guidelines, criteria used to select committee members and the selection process were rarely described. Committees developing guidelines rarely included an information scientist or a patient or patient representative. Non-English literature, unpublished data, and/or abstracts were rarely considered in developing guidelines; differences of opinion among committee members generally were not aired in guidelines; and benefits of recommendations were enumerated more often than potential harms. Guidelines published from 2006 through 2011 varied little with regard to average number of IOM standards satisfied.Conclusion: Analysis of a random sample of clinical practice guidelines archived on the NGC website as of June 2011 demonstrated poor compliance with IOM standards, with little if any improvement over the past 2 decades.