Standardized Reporting of Clinical Practice Guidelines: A Proposal from the Conference on Guideline Standardization

Standardized Reporting of Clinical Practice Guidelines: A Proposal from the Conference on Guideline Standardization

Richard N. Shiffman, MD, MCIS;
Paul Shekelle, MD, PhD;
J Marc Overhage, MD, PhD;
Jean Slutsky, PA, MSPH;
Jeremy Grimshaw, MB, ChB, PhD; and
Aniruddha M. Deshpande, MD

From Yale University School of Medicine and Yale Center for Medical Informatics, New Haven, Connecticut; Southern California Evidence-based Practice Center and University of California, Los Angeles, Los Angeles, California; Regenstrief Institute and Indiana University School of Medicine, Indianapolis, Indiana; Agency for Healthcare Research and Quality, Rockville, Maryland; and Ottawa Health Research Institute and the University of Ottawa, Ottawa, Ontario, Canada.

Abstract

Despite enormous energies invested in authoring clinical practice guidelines, the quality of individual guidelines varies considerably. The Conference on Guideline Standardization (COGS) was convened in April 2002 to define a standard for guideline reporting that would promote guideline quality and facilitate implementation. Twenty-three people with expertise and experience in guideline development, dissemination, and implementation participated. A list of candidate guideline components was assembled from the Institute of Medicine Provisional Instrument for Assessing Clinical Guidelines, the National Guideline Clearinghouse, the Guideline Elements Model, and other published guideline models. In a 2-stage modified Delphi process, panelists first rated their agreement with the statement that “[Item name] is a necessary component of practice guidelines” on a 9-point scale. An individualized report was prepared for each panelist; the report summarized the panelist's rating for each item and the median and dispersion of rankings of all the panelists. In a second round, panelists separately rated necessity for validity and necessity for practical application. Items achieving a median rank of 7 or higher on either scale, with low disagreement index, were retained as necessary guideline components. Representatives of 22 organizations active in guideline development reviewed the proposed items and commented favorably. Closely related items were consolidated into 18 topics to create the COGS checklist. This checklist provides a framework to support more comprehensive documentation of practice guidelines. Most organizations that are active in guideline development found the component items to be comprehensive and to fit within their existing development methods.

*For a list of participants in the COGS, see the Appendix.

Article and Author Information

Disclaimer: The opinions expressed are the authors and do not necessarily represent official policy of the Agency for Healthcare Research and Quality or the Department of Health and Human Services.
Acknowledgments: The authors thank the American Academy of Neurology, American Academy of Ophthalmology, American Academy of Periodontology, American Academy of Sleep Medicine, American College of Cardiology, American College of Chest Physicians, American College of Radiology, American Diabetes Association, American Medical Directors Association, American Optometric Association, American Society of Clinical Oncology, American Society of Plastic Surgeons, American Urological Association, Cincinnati Children's Hospital Medical Center, Eastern Association for the Surgery of Trauma, Infectious Diseases Society of America, Institute for Clinical Systems Improvement, Society of Nuclear Medicine, University of Michigan Health System, and the other organizations that participated in the survey.
Grant Support: The COGS meeting was supported by grant R13 HS10962 from the Agency for Healthcare Research and Quality. Dr. Shiffman's work is also supported by grants R01 LM07199 and R29-LM05551 from the National Library of Medicine.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Richard N. Shiffman, MD, MCIS, Yale Center for Medical Informatics, 300 George Street, Suite 501, New Haven, CT 065120; e-mail, Richard.Shiffman{at}yale.edu.
Current Author Addresses: Drs. Shiffman and Deshpande: Yale Center for Medical Informatics, 300 George Street, Suite 501, New Haven, CT 06511.
Dr. Shekelle: Greater Los Angeles Veterans Affairs Healthcare System 111G, 11301 Wilshire Boulevard, Los Angeles, CA 90073.
Dr. Overhage: Indiana University School of Medicine, 1050 Wishard Boulevard, Indianapolis, IN 46202.
Ms. Slutsky: Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, John M. Eisenberg Building, 540 Gaither Road, Rockville, MD 20850.
Dr. Grimshaw: Ottawa Health Research Institute, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada.