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. 2011 Sep 13:6:107.
doi: 10.1186/1748-5908-6-107.

The updating of clinical practice guidelines: insights from an international survey

Pablo Alonso-Coello  1 , Laura Martínez García, José Miguel Carrasco, Ivan Solà, Safia Qureshi, Jako S Burgers; Updating Guidelines Working Group
Collaborators, Affiliations

The updating of clinical practice guidelines: insights from an international survey

Pablo Alonso-Coello et al. Implement Sci. .

Abstract

Background: Clinical practice guidelines (CPGs) have become increasingly popular, and the methodology to develop guidelines has evolved enormously. However, little attention has been given to the updating process, in contrast to the appraisal of the available literature. We conducted an international survey to identify current practices in CPG updating and explored the need to standardize and improve the methods.

Methods: We developed a questionnaire (28 items) based on a review of the existing literature about guideline updating and expert comments. We carried out the survey between March and July 2009, and it was sent by email to 106 institutions: 69 members of the Guidelines International Network who declared that they developed CPGs; 30 institutions included in the U.S. National Guideline Clearinghouse database that published more than 20 CPGs; and 7 institutions selected by an expert committee.

Results: Forty-four institutions answered the questionnaire (42% response rate). In the final analysis, 39 completed questionnaires were included. Thirty-six institutions (92%) reported that they update their guidelines. Thirty-one institutions (86%) have a formal procedure for updating their guidelines, and 19 (53%) have a formal procedure for deciding when a guideline becomes out of date. Institutions describe the process as moderately rigorous (36%) or acknowledge that it could certainly be more rigorous (36%). Twenty-two institutions (61%) alert guideline users on their website when a guideline is older than three to five years or when there is a risk of being outdated. Twenty-five institutions (64%) support the concept of "living guidelines," which are continuously monitored and updated. Eighteen institutions (46%) have plans to design a protocol to improve their guideline-updating process, and 21 (54%) are willing to share resources with other organizations.

Conclusions: Our study is the first to describe the process of updating CPGs among prominent guideline institutions across the world, providing a comprehensive picture of guideline updating. There is an urgent need to develop rigorous international standards for this process and to minimize duplication of effort internationally.

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Figures

Figure 1
Figure 1
Participation diagram.
Figure 2
Figure 2
Box of relevant comments about the characteristics of the guideline-updating process.
Figure 3
Figure 3
Box of relevant comments about decision-making process of the need of updating.
Figure 4
Figure 4
Box of relevant comments about the characteristics of the search process.
Figure 5
Figure 5
Box of relevant comments about future plans for updating guidelines.
See this image and copyright information in PMC

References

    1. National Institute for Clinical Excellence. The guidelines manual. London: NICE; 2009.
    1. Scottish Intercollegiate Guidelines Network. SIGN 50: a guideline developer's handbook. Edinburgh: SIGN; 2008.
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ. GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. doi: 10.1136/bmj.39489.470347.AD. - DOI - PMC - PubMed
    1. Alonso-Coello P, Irfan A, Solà I, Gich I, Delgado-Noguera M, Rigau D, Tort S, Bonfill X, Burgers J, Schunemann H. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care. 2010;19(6):e58. - PubMed
    1. Burgers JS, Grol R, Klazinga NS, Makela M, Zaat J. Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual Health Care. 2003;15(1):31–45. doi: 10.1093/intqhc/15.1.31. - DOI - PubMed

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