Clinical/Practice Guidelines
 |
|
|---|
Clinical or practice guidelines are defined by the National Library of Medicine as works consisting of a set of directions or principles to assist the health care practitioner with patient care decisions about appropriate diagnostic, therapeutic, or other clinical procedures for specific clinical circumstances. Practice guidelines may be developed by government agencies at any level, institutions, organizations such as professional societies or governing boards, or by the convening of expert panels. They can provide a foundation for assessing and evaluating the quality and effectiveness of health care in terms of measuring improved health, reduction of variation in services or procedures performed, and reduction of variation in outcomes of health care delivered.
Clinical or practice guidelines usually cite references from a research study whose findings were used to support the recommendations as noted in the guideline.
There are specific resources that contain only clinical or practice guidelines and these can be searched using a variety of search queries. However, review of the literature can be helpful in locating evidence of clinical implementation from research study findings noted in practice guidelines. For example, a literature review using the query, “Ocular Hypertension Treatment Study” resulted in an article from a trade publication that provided information as to a practice guideline. As noted in the article:
There’s no question that measuring central corneal thickness is about to go mainstream, as a result of the Ocular Hypertension Treatment Study (OHTS) . . . corneal thickness emerged as such a powerful predictor that the OHTS study group recommended that Eye M.D.s consider checking the central corneal thickness of all ocular hypertensive patients. The Academy [American Academy of Ophthalmology] followed suit, and in a rare, midcycle revision of its Preferred Practice Pattern guidelines, endorsed pachymetry for POAG suspects.
(Source: Karmel, Miriam. Pachymetry Comes of Age. Eye Net. February 2003).
For resources that may be helpful for review of the literature, see Knowledge Transfer: Mass Media and Knowledge Transfer: Reviews.
Clinical/Practice Guidelines – Government
One example of a clinical/practice guideline related to glaucoma issued by a government agency is the U.S. Preventive Services Task Force (USPSTF) Screening for Glaucoma: Recommendation Statement. Evidence used to support the recommendations is noted in the Major Recommendations section.
Examples of other governmental agencies that issue clinical guidelines:
- Centers for Disease Control
- National Institutes of Health
- VA/DoD (Department of Veterans Affairs)
Clinical/Practice Guidelines – Specialty Organizations
In addition to government agencies, medical specialty societies or professional organizations that focus on a specific area of health care also produce clinical and practice guidelines. Medical specialty society guidelines are usually found on the website of the issuing organization.
For example, the American Academy of Ophthalmology issues Preferred Practice Guidelines. Preferred Practice Patterns (PPPs) are designed to identify characteristics and components of quality eye care. Developed by a panel of experts (the Quality of Care and Knowledge Base Development Secretariat and the PPP Committee) and based on the best available scientific data, PPPs provide guidance for the pattern of practice, not for the care of a particular individual. Guidelines are developed by the Academy without any external financial support. One example of a Preferred Practice Guideline is the Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern Guideline, 2005. The record for the AAO guideline in the National Guidelines Clearinghouse includes a section for evidence supporting the recommendations which lists references to published literature.
 |
National Guidelines Clearinghouse record for Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern Guideline |
Another example of a clinical guideline issued by a specialty organization is the American Optometric Association (AOA) which issues Optometric Clinical Practice Guidelines. Optometric Clinical Practice Guidelines (OCPGs) are recommendations for patient care which are developed through a formal process. They combine the best available current scientific evidence and research with expert clinical opinion to recommend appropriate steps in the diagnosis, management, and treatment of patients with various eye and vision conditions. Each of the optometric practice guidelines has been developed by a consensus panel of optometrists who were selected for their knowledge and experience in that area. The guidelines have gone through extensive review processes within AOA and represent a broad consensus on guidelines for current optometric care.
Examples of specialty society or professional organizations that issue clinical guidelines:
- American College of Physicians
- American Speech, Language and Hearing Association
- American Academy of Pediatrics
Clinical/Practice Guidelines – Other
Guidelines are also produced by vendors or organizations not affiliated with a governmental agency or specialty organization. One example of this type of guideline is the Evidence-Based Care Sheets produced by Current Index to Nursing and Allied Health Information (CINAHL). The CINAHL Evidence-Based Care Sheets include a list of references used to support the guidelines.
Assessment
Review of clinical or practice guidelines are required to locate evidence that findings from a research study were used as support for implementation of a guideline. Review of the literature can also be helpful in locating evidence of clinical implementation from research study findings noted in clinical or practice guidelines. For resources that may be helpful for review of the literature, see Knowledge Transfer: Mass Media and Knowledge Transfer: Reviews. Contact with policy-makers may be required in order to confirm that findings from a research study resulted in a new or revised clinical or practice guidelines.
 |
Search using the keywords; title of the research study; the disease, disorder or condition; the specific medical specialty of the disease, condition or disorder; or name of the primary investigator/s. |
|---|
The following resources are useful for locating clinical or practice guidelines. Searching among these resources may produce duplicate results and may also include Quality Measure Guidelines.
Agency for Healthcare Research and Quality (AHRQ)
The mission of the Agency for Healthcare Research and Quality (AHRQ) includes both translating research findings into better patient care and providing policymakers and other health care leaders with information needed to make critical health care decisions. In doing so, AHRQ sponsors the development of a number of guidelines. The guidelines include:
- Clinical Practice Guidelines
- AHRQ clinical practice guidelines link to the National Guideline Clearinghouse (NGC). NGC is a publicly available database of evidence-based clinical practice guidelines and related documents.
- Effective Health Care Reports
- The Effective Health Care Program is dedicated to facilitating decision making by providing findings from high-quality research in formats for different audiences.
- Evidence Reports
- AHRQ’s Evidence-based Practice Centers (EPCs) produce evidence reports to provide to public and private organizations the foundation for developing and implementing their own practice guidelines, performance measures, educational programs, and other strategies to improve the quality of health care and decision-making related to the effectiveness and appropriateness of specific health care technologies and services. EPCs also produce technology assessments. See Health Technology Assessments section.
- Outcomes and Effectiveness Reports
- Outcomes research seeks to understand the end results of particular health care practices and interventions. End results include effects that people experience and care about, such as change in the ability to function. In particular, for individuals with chronic conditions – where cure is not always possible – end results include quality of life as well as mortality. By linking the care people get to the outcomes they experience, outcomes research has become the key to developing better ways to monitor and improve the quality of care. Supporting improvements in health outcomes is a strategic goal of AHRQ.
- Technology Assessments
- AHRQ’s Evidence-based Practice Centers (EPCs) produce evidence reports and technology assessments to provide to public and private organizations the foundation for developing and implementing their own practice guidelines, performance measures, educational programs, and other strategies to improve the quality of health care and decision-making related to the effectiveness and appropriateness of specific health care technologies and services. EPCs also produce technology assessment. See: HTA 101: Introduction to Health Technology Assessment.
- U.S. Preventative Services Task Force Recommendations
- The U.S. Preventive Services Task Force (USPSTF) issues recommendations on screening, counseling, and preventive medication topics for general practitioners, internists, family practitioners, pediatricians, nurses, and nurse practitioners with an authoritative source for making decisions about preventive services.
CINAHL Plus Evidence-Based Care Sheets
CINAHL Plus provides indexing for 3,802 journals from the fields of nursing and allied health, with indexing back to 1937. CINAHL Plus also contains searchable cited references for more than 1,270 journals. Included in CINAHL Plus are Evidence-Based Care Sheets. There are over 300 Evidence Based Care Sheets that contain summaries of treatment for specific conditions that include references to published studies and other sources of supporting documentation. Select Evidence-Based Care Sheets from the top of the main search page.
 |
CINAHL Plus home page |
Cochrane Library – Economic Evaluations Database (EED)
The Cochrane Library contains high-quality, independent evidence to inform healthcare decision-making. It includes reliable evidence from Cochrane and other systematic reviews, clinical trials, and more. Cochrane reviews bring you the combined results of the world’s best medical research studies, and are recognized as the gold standard in evidence-based health care.
As healthcare resources are finite, information about both costs and effects are essential to making evidence-based decisions about competing healthcare interventions. But information about cost-effectiveness can be difficult to identify, appraise and interpret. The Cochrane Library Economic Evaluations Database (EED) assists decision-makers by systematically identifying economic evaluations from around the world, appraising their quality and highlighting their relative strengths and weaknesses. The database contains over 5000 abstracts of quality-assessed economic evaluations. EED is produced by the Centre for Reviews and Dissemination (CRD) at the University of York, UK.
From the main page of the Cochrane Library, select Economic Evaluations. Search tips are noted on the EED main page.
 |
Cochrane Library home page |
Cochrane Library – Health Technology Assessment Database (HTA)
The Cochrane Library consists of a regularly updated collection of evidence-based medicine databases to inform healthcare decision-making. Cochrane provides additional resources such as other systematic reviews, abstracts, technology assessments, economic evaluations, and individual clinical trials.
The Cochrane Library offers a Health Technology Assessment Database (HTA) that allows for searching of health technology assessments. The HTA database brings together details of completed and ongoing health technology assessments (studies of the medical, social, ethical and economic implications of healthcare interventions) from around the world. The aim of the database is to improve the quality and cost-effectiveness of health care. The HTA database is produced by the Centre for Reviews and Dissemination (CRD) at the University of York, UK, using information obtained from members of INAHTA and other health technology assessment organizations.
From the main page of the Cochrane Library, select Technology Assessments. Search tips are noted on the main page.
 |
Cochrane Library home page |
MD Consult
MD Consult provides access to practice guidelines from over 150 professional and governmental agencies. Browsing by topic, specialty and authoring organization is available. From the main page, select Guidelines. Options for searching include keyword or by topic, specialty, or authoring organization.
 |
MD Consult home page |
MD Consult/First Consult
First Consult is part of the MD Consult knowledge system. Its guides contain evidence-based and updated clinical information resources for healthcare professionals designed for use at point of care. The guides provide access to information on evaluation, diagnosis, clinical management, prognosis, and prevention. From the main page, select First Consult. Medical topics, differential diagnoses and procedures are available for searching using an alphabetical list.
 |
MD Consult home page |
National Guideline Clearinghouse
The National Guideline Clearinghouse (NGC) is a comprehensive database of evidence-based clinical practice guidelines and related documents. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America’s Health Insurance Plans [AHIP]). The NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.
For a clinical practice guideline to be considered for the NGC, it must meet these criteria:
- The guideline must contain systematically developed recommendations, strategies, or other information to assist health care decision making in specific clinical circumstances
- The guideline must have been produced under the auspices of a relevant professional organization (e.g., medical specialty society, government agency, health care organization, or health plan)
- The guideline development process must have included a verifiable, systematic literature search and review of existing evidence published in peer-reviewed journals
- The guideline must be current and the most recent version (i.e., developed, reviewed, or revised within the last 5 years)
Additional Resources:
National Information Center on Health Services Research and Health Care Technology (NICHSR) Databases and Retrieval Services
National Information Center on Health Services Research and Health Care Technology (NICHSR) provides several databases for searching of health technology assessments.
PubMed
PubMed is a freely accessible online database of biomedical journal citations and abstracts created by the U.S. National Library of Medicine (NLM). Approximately 5,200 journals published in the United States and more than 80 other countries are indexed in PubMed.
PubMed offers a search option to search for practice guidelines. From the PubMed home page, select the Advanced Search option. Scroll down to the Type of Article box and check Practice Guideline.
 |
PubMed Advanced Search option page showing Practice Guideline filter |
Back to Top
Last updated: May 4, 2009