Last week the NIH Heart, Lung and Blood Institute announced it was no longer going to produce guidelines, rather concentrate on evidentiary reviews and collaboration with external partners (http://www.nhlbi.nih.gov/about/directorscorner/messages/2013-messages/june-2013/nhlbi-adopts-new-collaborative-partnership-model-for-clinical-practice-guidelines-development/index.html). In highlighting the recent IOM reports on Trustworthy Guidelines and Systematic Reviews this announcement clearly put the onus on professional medical societies to take the lead role in the sometimes contentious, always interesting balancing of ambiguous evidence and clinical need for clarity. Also related was the American Society of Hypertension taking over the hypertension guidelines (http://www.prnewswire.com/news-releases/american-society-of-hypertension-assumes-charge-of-hypertension-guideline-development-212400321.html). Strange that this came from ASH not NHLBI and begs the question on the collaboration model - who chooses them? There's always a loss of control that the government faces when it releases information, which evidence syntheses are and what will happen. There will be those formal collaborations and there will be other guidelines developers who will also use the information to develop their own guidelines. At that point there will be no getting around the need for an independent arbitrator to assess guideline quality - maybe something AHRQNIH should be doing now
New NGC Inclusion Criteria Announced - Starting in June 2014, submissions to the Guidelines Clearinghouse will need to meet IOM standards for Systematic Reviews and Assessment of the Benefits and Harms (www.guideline.gov/about/inclusion-criteria.aspx)
The Guidelines Clearinghouse has responded to the challenge of the 2011 IOM reports on systematic review and trustworthy guidelines (www.iom.edu/activities/quality/clinicpractguide.aspx) with minimal standards for inclusion. At first glance the requirements for documented systematic reviews may be viewed as a significant step but it is only a step in the goal of trustworthiness. It is unclear how SR documentation submitted will be used to make an inclusion determination. Is it simply a matter of supplying the documentation or will there be any evaluation of the accuracy of the data? Will end users be able to have access to supporting documents to make their own evaluations? I hope were not moving towards a process where the quality of systematic reviews (more references, bigger evidence tables) determines inclusion. Some questions, which need to be addressed and included, do not lend themselves to absolutes for inclusion criteria. Other criteria such as summaries of the benefits and harms of recommended treatment are similarly unknown as to implementation. Who is, or is anyone at AHRQ going to assess the veracity of these summaries? And if so how?
These are not easy questions to answer. And if its AHRQ's position that they are merely going to check off that these documents are present to acknowledge a minimal, indirect quality assessment they should say so. But, developers of competing guidelines realize that the pathway to trustworthiness and harmonization is much more complicated.