Guest Editorial: Guideline Clearinghouse Updates Inclusion Criteria

  Evidence-based clinical practice guidelines (CPGs), which guide decisions regarding care, are fundamental to high-quality healthcare. Healthcare providers have long regarded the National Guideline Clearinghouse™ (NGC) as an indispensable, publicly accessible collection of CPGs developed by various organizations and clinician groups.¹ Healthcare providers, organizations, and ultimately patients benefit greatly from the dissemination, implementation, and use of these guidelines.

  The NGC, created by the Agency for Healthcare Research and Quality (AHRQ) in partnership with major healthcare industry organizations, has used the same inclusion criteria for guidelines since the clearinghouse went live in 1998. At the time, those criteria represented the state-of-the-art in guideline development and followed the Institute of Medicine’s (IOM) definition of CPGs. But like healthcare itself, the science supporting CPG inclusion criteria evolves as the evidence base improves.   In March 2011, the IOM updated its definition of CPGs. The IOM now defines these guidelines as “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.”² This marked the first update of the IOM’s definition of CPGs in more than two decades and includes standards for guideline development. The NGC has followed suit by updating its inclusion criteria to reflect these advances in CPG development.

  The updated inclusion criteria, which take effect June 2014, can be found at www.guideline.gov/about/inclusion-criteria.aspx. They are based on the principles that CPGs should assist clinical decision-making, be based on a systematic review of evidence, be available for use, be current, be written in English, and be developed by organizations rather than individuals.³

  These principles are essentially unchanged from the principles that NGC used to establish inclusion criteria initially. This is because the definition of “evidence-based” has not changed. That said, the revised criteria now provide clarity and precise instructions to guidelines developers. The summarized criteria are:
    1. The CPG must contain systematically developed statements including recommendations intended to optimize patient care.
    2. The CPG must be produced under the auspices of a medical specialty association; relevant professional society; public or private organization; government agency at the federal, state, or local level; or healthcare organization or plan.
    3. The CPG must be based on a systematic review of evidence.
    4. The CPG or its supporting documents must contain an assessment of the benefits and harms of recommended care and alternative options.
    5. The full text guideline must be available in English to the public upon request.
    6. The CPG must have been developed, reviewed, or revised within the past 5 years.⁴

  Criteria 3 and 4 reflect the two main changes to the updated criteria. Both of these changes ensure that future CPGs will be more in line with the IOM’s latest thinking on evidence-based care, which relies on analyses of existing evidence for clinical decision-making.

  Medical professionals who work in ostomy care, wound care, and incontinence care and on related skin and nutritional issues will find many guidelines in the NGC to help them ensure they are providing care that meets the highest standards. The NGC’s website, www.guideline.gov, features an intuitive search function on its home page and allows users to run advanced searches within major topics. It also allows users to compare guidelines in side-by-side format and create their own personalized list.

  Syntheses of guidelines are provided at the NGC site, showcasing areas of similarity and differences among guidelines on the same topic. As of this writing, prevention of pressure ulcers is a topic featured among more than 20 guideline syntheses.

  By staying current with guideline development criteria, the NGC can ensure both that the guidelines themselves are current and that the healthcare system is safe, timely, effective, efficient, equitable, and patient-centered for all Americans.

1. Agency for Healthcare Research and Quality. National Guideline Clearinghouse home page. Available at: www.guideline.gov. Accessed August 9, 2013.

2. Graham R, Mancher M, Wolman DM, et al (eds). Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Press;2011.

3. Nix M, Slutsky J. The National Guideline Clearinghouse’s Revised Criteria for Clinical Practice Guideline Inclusion. Presentation to G-I-N North America. San Francisco, CA. June 27, 2013.

4. Agency for Healthcare Quality and Research. National Guideline Clearinghouse Inclusion Criteria. Available at: www.guideline.gov/about/inclusion-criteria.aspx. Accessed August 9, 2013.