Next Steps: Implementation Workshop on Standards for Systematic Reviews and Clinical Practice Guidelines Institute of Medicine Sandra Zelman Lewis, PhD American College of Chest Physicians Sandra Zelman Lewis, PhD American College of Chest Physicians May 10-11, 2010

Role and Relevance  Oversee development and implementation of ACCP evidence-based clinical practice guidelines and consensus statements  Evidence-based derivative products  Implementation efforts  Develop and guide methodology  Education in EBM methodology

Impact of the IOM Reports  ACCP is pleased with the IOM reports o They raise the bar o They define trustworthiness of EB guidelines But would have liked to reserve the title “Guidelines” for trustworthy guidelines  ACCP meets nearly all of the IOM standards for trustworthy guidelines o A few met in part but can fairly readily achieve full compliance Intellectual COIs (currently only one guideline)  Aim to meet nearly all IOM standards

Impact  But there is one IOM standard we will never meet: o Cannot post content ahead of publication for public comments o Violation of the embargo  And one standard we are not likely to meet very soon - Patient or public involvement o Discouraging experience with aggressive patient advocacy group o Decision made to use instead:  Ethicists  Professionals in patient values/preferences  EBM-trained consumers

Strategies  Maintaining currency:  Annual reviews  Living guidelines model  Articulation of recommendations  Describe patient population first  Strong: “We recommend” and Weak: “We suggest”  External reviews and harmonization  Invited related associations/organizations Invited panelists/representatives Reviews for endorsements (NDAs)  Reviewing and managing conflicts of interest  Rigorous reviews and high standards  Financial and intellectual  Methodologists as chapter editors in key areas health economists, frontline clinicians  COI grid – applicable to individual recommendations

Conflict of Interest Example of COI Grid Recommend ation Chapter EditorDeputy EditorCo-author 1Co-author 2 Co-author 3 Co-author 4 typedescriptiontypedescriptiontypedescriptiontypedescriptiontypedescriptiontypedescription Rec 1 Rec 2 2ryGdln Author Rec 3 2ryPI 2ryGdln Author Rec 4 1ryConsult 1rySpeaker Rec 5 1ryAdvisory1ry Rec 6 2ryPI

Questions?

Standards ACCP Meets identify strategies for implementing the standards. Some topics you may want to address in your presentations include: examples of how your organization is implementing the standards, lessons learned from implementation efforts, strategies for overcoming barriers to implementation, suggestions on the types of resources and support you will need to implement the standards (beyond additional funding), and potential areas for collaboration in conducting systematic reviews and guidelines