Methods Chapter 2 Gillian Booth, Alice YY Cheng Canadian Diabetes Association 2013 Clinical Practice Guidelines.

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Presentation transcript:

Methods Chapter 2 Gillian Booth, Alice YY Cheng Canadian Diabetes Association 2013 Clinical Practice Guidelines

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Methods – Guiding Principles Building on 2008 CPGs Rigorous, evidence-based Transparency – process, evidence that guidelines are based on and how we evaluated that evidence Fulfill criteria outlined in AGREE II instrument Harmonization with other guidelines

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association International Recognition of 2008 CDA CPGs

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Systematic review of 11 international guidelines on oral medication for T2DM Assessed for consistency with the evidence Assessed for quality – Rigor of development – Editorial independence Conducted by the Johns Hopkins University Evidence-Based Practice Center International Recognition of 2008 CDA CPGs (continued)

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association The Process 1.Develop clinical questions 2.Centralized literature search (X3) 3.Review of literature search 4.Write preamble and recommendations 5.Every recommendation reviewed and approved by 100% consensus of Steering Committee

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association The Process (continued) 6.External Review (national, international) 7.Independent Methods Review 8.Final approval of Steering Committee 9.Publication 10.Dissemination and Implementation

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Identifying Articles Identifying clinically important questions – Treatment or prevention – Diagnosis – Prognosis Centralized literature search – Systematically conducted lit searches – Known articles – Manual search of listed citations from articles

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Rating the Evidence Highest available level of evidence Relevant studies Formally assign each a level of evidence

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Same standardized approach as in 2008 Set of ‘rules’ to rate studies of a certain type (prevention/treatment, diagnosis, prognosis) Rating depends on study design plus strengths and weaknesses of the study Rating the Evidence (continued)

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Formulating a Recommendation 1) Recommendation What the evidence says 2) Grade What the highest level of evidence is 3) Reference(s) Study which provides the highest level of evidence

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Grading Recommendations Grade Best Evidence ALevel 1 BLevel 2 CLevel 3 DLevel 4 High level RCT(s) or systematic review / meta-analysis of RCTs RCT(s) or systematic review/meta-analysis Cohort studies Case control studies, case series

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Grading Recommendations (continued) Grade Level of confidence AHigher B C DLower

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Scope and Purpose Stakeholder involvement Rigour of development Applicability Editorial independence AGREE II

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association AGREE II Criteria

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association AGREE II Criteria (continued)

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association AGREE II Criteria (continued)

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association AGREE II Criteria (continued)

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association AGREE II Criteria (continued)

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association AGREE II Criteria (continued)

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Independent Methods Review Process More than 200 articles 85 recommendations 27 chapters 17 hours of meeting time 10 hour face to face meeting hour teleconferences x

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Gillian Booth (Chair) University of Toronto Doreen Rabi University of Calgary Dereck Hunt McMaster University Charlotte McDonald University of Western Ontario Valerie Palda University of Toronto Sonia Butalia University of Calgary 2013 Independent Methods Review Committee

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Changes to Methods in 2013 Multiple literature searches throughout period Evidence resource persons as chapter authors Publishing evidence-based worksheets Committee struck to consider how to incorporate cost and/or cost-effectiveness into CPGs 2013

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Duality of Interest No employees of a pharmaceutical or device company No board membership of a pharmaceutical or device company Disclosure of duality of interest at the beginning of each steering committee meeting Duality of interest details publicly available 2013

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association cal_4conflicts.html

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Funding Sources Canadian Diabetes Association (general funds) Unrestricted educational grants – Merck Canada Inc, Novo Nordisk Canada Inc, Eli Lilly Canada Inc, Bristol-Myers Squibb / AstraZeneca collaboration, Novartis Pharmaceuticals Canada Inc. Companies were not involved in any aspect of guideline development and did not have access to guideline meetings, guideline drafts or committee deliberations 2013

guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association CDA Clinical Practice Guidelines – for professionals BANTING ( ) – for patients