Transparency, objectivity, and consistency are criteria that should form the foundation for new standards for clinical practice guidelines and systematic reviews, according to two reports recently released by the Institute of Medicine (IOM). The reports were commissioned by Congress following passage of the 2008 Medicare Improvement for Patients and Providers Act. Among other features, the reports argue for the role of medical librarians in overseeing sound literature search strategies when systematic reviews and guidelines are being developed.
With the explosion in medical literature, physicians and other health care providers have come to rely on practice guidelines and systematic reviews for their synthesis of the literature and evidence-based approach to patient care. However, the number of clinical guidelines produced has also risen substantially since the early 1990s. In fact, the National Guideline Clearinghouse and the Guidelines International Network, two premier guidelines databases, now include more than 9,500 guideline standards.
Unfortunately, the methods behind creating all these guidelines and systematic reviews vary so greatly that stakeholders have increasingly questioned their quality and reliability. Each of the two new IOM reports sets out to establish “gold standard” practices at a critical time in the health care reform movement.
A key element of both reports is an emphasis on making clinical practice guidelines more inclusive of and accessible by patients and the public. To achieve this goal, the Institute of Medicine identified eight areas for improvement of guideline development, including process transparency, disclosure of all conflicts of interest, and a rating scale for strength of recommendations among others.
The Guidelines companion report on improving systematic reviews sets a similarly high bar. The report notes that the quality of current systematic reviews varies widely from excellent to poor. To strive for quality and usability across the board, the IOM report recommends 21 standards for producing high-quality systematic reviews.
Standard 3.1 is of particular importance to the systematic review project team. The elements of this standard address conducting a comprehensive, systematic search of the literature for evidence. It specifically recognizes the importance of working with “a librarian or other information specialist trained in performing systematic reviews to plan the search strategy” (Standard 3.1.1) as well as using “an independent librarian or other information specialist to peer review the search strategy” (Standard 3.1.3).
Right now, it’s unclear how organizations that develop clinical practice guidelines and systematic reviews will handle the challenges of these new recommendations. The key goal for the Institute of Medicine continues to be restoring trust in the process of assessing medical evidence and applying that evidence to the development of quality clinical guidelines and systematic reviews.
Both Institute of Medicine reports : Clinical Practice Guidelines We Can Trust (W 84.4 AA1 I59c 2011 ) and Finding What Works in Health Care: Standards for Systematic Reviews (W 84.3 I59c 2011 ) are available at the Dana Medical Library.