American Thoracic Society. Topics

Transcription

1 Topics Why do guidelines require a methodologist? Why are guidelines be limited to six PICO questions? Why must guidelines be completed within two years?

2 Topics Why do guidelines require a methodologist? Why are guidelines be limited to six PICO questions? Why must guidelines be completed within two years?

3 Need for close oversight American

4 Need for close oversight Re defined clinical practice guidelines as: Clinical practice guidelines include recommendations informed by a systematic review of evidence that assesses the benefits and harms of alternative options. A systematic review focuses on a specific question and uses explicit scientific methods to identify, select, assess, and summarize of separate studies.

5 Need for close oversight Adherence to the standards proved difficult: Tried to educate the chairs and committees suboptimal result. Hired ATS methodologist to provide help upon request suboptimal result. Established liaisons to facilitate communication between guideline committees and the ATS methodologist suboptimal result.

6 Need for close oversight What were the suboptimal results? Guideline projects left incomplete Guideline projects terminated due to poor progression Guideline projects re started from scratch Guideline projects converted to review articles Guideline projects converted to clinical statements

7 Need for close oversight Adherence to the standards proved difficult: Began requiring an on committee, experienced methodologist for every committee finally, success.

8 Topics Why do guidelines require a methodologist? Why are guidelines be limited to six PICO questions? Why must guidelines be completed within two years?

9 Rationale for six or fewer PICO questions (i.e., comparisons) Duration (years) Number of PICO questions

10 Rationale for six or fewer PICO questions (i.e., comparisons) Duration (years) PICO questions = possible to finish within two years Number of PICO questions

11 Rationale for six or fewer PICO questions (i.e., comparisons) Duration (years) >10 PICO questions = will not finish within two years Number of PICO questions

12 Rationale for six or fewer PICO questions (i.e., comparisons) Reasons: Workload; more questions = more work = more time. Completed questions become outdated before questions that are still in development are finished, which requires committees to go back, repeat the literature search and review, and sometimes also redo analyses and decision making. Project fatigue, burnout, loss of interest

13 Topics Why do guidelines require a methodologist? Why are guidelines be limited to six PICO questions? Why must guidelines be completed within two years?

14 Rationale for requiring submission within two years

15 Rationale for requiring submission within two years ATS only has the resources to begin 4 guidelines each year and to have 8 guidelines in development at any given time. Failure to complete a guideline within 2 years will cause the projects to accumulate and the strategy will become unsustainable. Failure to submit a guideline within two years.... Publish whatever is completed, even if the project as a whole is incomplete. Finish the guideline as a clinical statement instead of a guideline. Turn the project over to ATS staff to complete. Terminate the project.

16 Rationale for requiring submission within two years January April 2018: Conflict of interest disclosure, panel composition, PICO question selection, outcome identification, outcome prioritization. May 2018: Face to face meeting organizational, educational, and approval of PICO questions and outcomes (if not already complete). June 2018 April 2019: Methodologist performs or leads evidence synthesis with frequent input from chairs and committee. May 2019: Face to face meeting Methodologist presents evidence synthesis, co chairs lead discussion of evidence, and the recommendations formulated. June 2019 December 2019: Manuscript preparation.

17 Rationale for requiring submission within two years Top down strategy is meant to be in addition to, not instead of the traditional bottom up pathway: The Executive Committee increased funding for the bottom up projects last year. $250,000 $350,000 The Executive Committee also added new funds for the top down guidelines last year. $150,000

18 Questions? American