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Rigorous development does not ensure that guidelines are acceptable to a panel of knowledgeable providers
Teryl K Nuckols1, Yee-Wei Lim, Barbara O Wynn
1RAND Corporation, Santa Monica, CA, USA. teryl@rand.org
Journal of General Internal Medicine
|November 22, 2007
Summary
Even with rigorous development, clinical guidelines may lack perceived relevance and validity. Further evaluation of guideline acceptability is crucial before widespread adoption.
Area of Science:
- Clinical Practice Guidelines
- Healthcare Quality Improvement
- Evidence-Based Medicine
Background:
- Rigorous guideline development aims for provider acceptability by ensuring relevance and evidence consistency.
- However, the link between technical quality and clinical acceptability remains unexamined.
Purpose of the Study:
- To assess the clinical acceptability of guidelines possessing excellent technical quality.
Main Methods:
- Five musculoskeletal disorder guidelines meeting technical quality criteria were evaluated using the AGREE Instrument.
- A multidisciplinary expert panel used a modified Delphi method to rate guideline acceptability (comprehensiveness and validity) for common conditions.
Main Results:
- All selected guidelines demonstrated high technical quality via AGREE scores.
- Despite this, experts found 4 guidelines only moderately comprehensive and valid; one was deemed invalid.
- Panelists rated only 50%-69% of topics as comprehensive and 6%-50% as valid.
Conclusions:
- Experts perceived that rigorously developed guidelines omitted common clinical scenarios and contained uncertain validity.
- Independent and formal evaluation of guideline acceptability is recommended prior to dissemination.
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