Chest
Volume 132, Issue 3, September 2007, Pages 1015-1024
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ACCP Evidence-Based Guideline Development: A Successful and Transparent Approach Addressing Conflict of Interest, Funding, and Patient-Centered Recommendations

https://doi.org/10.1378/chest.07-1271Get rights and content

Evidence-based clinical practice guidelines (EBGs) can provide an invaluable distillation of knowledge regarding best practices based on the available evidence. EBGs, providing accurate and useful guidance to best clinical practices, require a rigorous development process. The American College of Chest Physicians (ACCP) has developed a process that embodies transparency, thoroughness, and timeliness, and effective conflict-of-interest management, and it continues to evolve. This process employs a quantitative and rigorous grading of the strength of recommendations and of the quality of evidence that incorporates sensitivity to health-care resource utilization and patient values and preferences. A review of this process is provided to inform the ACCP membership and those wishing to embark on EBG development.

Section snippets

Characteristics of an EBG

EBGs are defined as a systematically developed set of recommendations, algorithms, and other information to assist health-care decision making in specific clinical circumstances. EBGs represent the synthesis of evidence derived from a formal, thorough, and systematic review of the literature that results in the compilation of a set of specific literature-based recommendations addressing specifically identified clinical questions. An EBG must be distinguished from a consensus statement, which is

Establishment of an Oversight Committee

The ACCP Health and Science Policy Committee (HSP) provides oversight for the development of ACCP-generated EBGs. It is charged with the responsibility of choosing the topic and maintaining the integrity of all EBGs as well as the process used to develop them. The HSP ensures that EBGs are scientifically sound and are based on the available evidence as determined by rigorous reviews of the literature. Further, the HSP continuously evaluates and improves the rigorous basis for this development

Selection of Guideline Topics

New EBG topics are generated through an application process by individual ACCP members or by a committee of the ACCP. These suggestions are brought to the HSP for assessment. The application requires an assessment of the importance of the topic, including the variability in practice patterns, the level of controversy regarding the topic, the availability of interventions that have high societal or economic cost, the breadth of the constituency impacted, the importance to public health, and the

Collaboration With Other Medical Societies and Organizations

Early in the guideline development process, variable degrees of collaboration are sought with relevant organizations and medical specialty societies that bring important perspectives such as complementary clinical expertise or patient advocacy. A Memorandum of Agreement defines organizational responsibilities and expenses, as well as the conditions for publication, authorship, the management of conflicts of interest, endorsement, profits, and termination. This memorandum is customized to meet

Conflicts of Interest and Relations With Industry

The “Conflict of Interest Policy for ACCP Guideline Development”7 outlines a process ensuring that disclosed conflicts of interest are properly evaluated and resolved at several key points during the development of the EBG. This policy statement includes an explicit and detailed step-by-step procedure to collect and evaluate the disclosed conflicts respective to the guideline topic, and make recommendations to resolve or manage the conflict. The conflict-of-interest assessment flowchart (Fig 1)

EBG Writing Panel Selection

Chairs discuss the initial scope of the guideline and suggest experts in each subtopic. The initial literature review helps to identify content experts who have extensive publication experience in the clinical area. The selection process identifies panel members. In addition to strong clinical and methodological expertise, selection criteria include reliability, the ability to work collaboratively, anticipated productivity, and gender, minority, and geographic diversity.

All EBG writing panel

EBG Writing Process

A project time line (Table 1) is drafted once the decision is made to develop an EBG and the project is approved by the Board of Regents. The ACCP project manager and EBG Executive Committee (composed of the chair, the methodologist, and a liaison from the HSP) are responsible for keeping the entire panel within the project deadlines. The HSP is regularly updated.

The EBG Executive Committee and the ACCP staff project manager convene regular conference calls to review administrative and content

EBG Review

Based on the proceedings of the final conference, revisions are made to the guideline that is then forwarded to several groups within the ACCP for review and revision. (Fig 2.) Appropriate ACCP NetWorks are charged with content review. The HSP reviews process, consistency, whether the recommendations and grading are appropriate, and content. After the writing group adequately addresses the critiques provided by HSP and NetWork reviewers, the guideline manuscript is submitted to the ACCP Board

Dissemination and Marketing

A “Clinical Resource Tool” is created for most ACCP EBGs. This product is a combination print and CD-ROM implementation tool kit that is based on the clinical practice guideline. Standard components include the Quick Reference Guide for Clinicians, patient education materials, and slides for presentations to lay and medical audiences. Additional materials, such as physician order sets, can also be added. The Quick Reference Guide for Clinicians includes all clinical algorithms and the key

Conclusion

EBG development is a collaborative and complex endeavor. However, when parsed into specific domains including topic selection, writing panel selection, conflict-of-interest declaration and resolution, an explicit time line, evidence grading and recommendation development, comprehensive guideline review, and creating and maintaining appropriate and robust firewalls, the process is transparent and manageable. We present a systematic strategy that has been successful for the ACCP. However, this

ACKNOWLEDGMENT

The authors wish to acknowledge Alvin Lever, MA, FCCP (Honorary), Executive Vice President and CEO of the ACCP, who provided invaluable encouragement and support to consolidate the many efforts in refining the ACCP EBG development process into a published document. The authors also acknowledge the many contributions of current and past members of the ACCP HSP and of the HSP staff, and the contributions of many other ACCP members to the successful evolution of the ACCP EBG development process.

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