Conflict of Interest in Clinical Practice Guideline Development

描述(由申请人提供)：拟议的研究试图检查财务利益冲突与临床实践指南中的建议之间的关系。本申请概述了在实践指南的重要部分中描述当前行业关系水平的方法，特别是那些关于糖尿病血糖控制的指南。我们将研究行业关系对质量的影响，并在这些实践指南中提出具体建议。具体目的是：1)评估糖尿病血糖控制药物治疗实践指南所依据的比较有效性系统评价的质量；2)确定实践指南的质量和稳健性；3)描述实践指南发起人和作者与行业的财务关系；以及4)检查行业、指南作者和发起人之间的关系，以及指南建议。 我们将在国家指南信息交换中心确定所有相关的实践指南，(Tm)获得每个实践指南所依据的比较有效性审查，并评估这些审查的质量。将评估每个实践指南的质量，我们将使用每个指南的基本比较有效性审查和明确的框架独立地提出建议。然后，我们将把原始实践指南中的建议与我们的建议进行比较，以评估每项建议的稳健性。将确定每个指南的作者和发起人与行业的财务关系的频率和类型，我们将审查这些关系与实践指南的质量和稳健性之间的关联。然后，我们将研究与行业的财务关系对支持行业建议的百分比的影响。医疗保健提供者和患者必须信任向他们提供的信息。利益冲突可能会使信息产生偏见，从而破坏这种信任，降低研究或指南的可信度，并最终可能导致次优的患者护理，甚至伤害。了解行业关系的影响将有助于准则发起人制定适当的政策来管理利益冲突。

DESCRIPTION (provided by applicant): The proposed research seeks to examine the relationship between financial conflicts of interest and recommendations in clinical practice guidelines. This application outlines an approach to describe the current level of industry relationships in an important segment of practice guidelines, specifically those on glycemic control in diabetes. We will examine the impact of industry relationships on the quality and specific recommendations in these practice guidelines. The specific aims are to: 1) assess the quality of the comparative effectiveness systematic reviews upon which practice guidelines for the pharmacotherapy of glycemic control in diabetes were based; 2) determine the quality and robustness of practice guidelines; 3) describe the financial relationships with industry among practice guideline sponsors and authors; and 4) examine relationships between industry, guideline authors and sponsors, and guideline recommendations. We will identify all relevant practice guidelines in the National Guidelines Clearinghouse,(tm) obtain the comparative effectiveness reviews upon which each practice guideline was based, and assess the quality of these reviews. The quality of each practice guideline will be assessed and we will independently generate recommendations using the underlying comparative effectiveness reviews for each guideline and an explicit framework. We will then compare the recommendations in the original practice guideline with our recommendations to assess the robustness of each recommendation. The frequency and type of financial relationships with industry for the authors and sponsor of each guideline will be identified, and we will examine the associations between those relationships and the quality and robustness of the practice guidelines. We will then examine the impact of financial relationships with industry on the percentage of pro-industry recommendations. Healthcare providers and patients must trust the information that they are provided with. Conflicts of interest can bias that information, which breaks that trust, decreases the credibility of the research or guidelines, and may ultimately lead to suboptimal patient care or even harm. Understanding the impact of industry relationships will help guideline sponsors to develop appropriate policies for managing conflict of interest.