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A Guideline for Guidelines: A Novel Method to Assess the Helpfulness of Medical Guidelines
Akos Koller1,2,3,4, Johanna Takács5
1Department of Physiology, New York Medical College, Valhalla, NY 10595, USA.
Insights
A new mathematical analysis assesses medical guideline (GL) quality. It found the 2020 Sports Cardiology Guidelines offer clear recommendations but often with lower-quality evidence, highlighting a need for quality control.
Area of Science:
- Cardiology
- Medical Informatics
- Evidence-Based Medicine
Background:
- Medical guidelines (GLs) aid clinical decision-making but lack systematic methods for assessing helpfulness and quality.
- Objective assessment tools are needed to evaluate the reliability of recommendations within GLs.
- This study addresses the need for a quantitative method to measure GL quality.
Purpose of the Study:
- To develop and validate an objective mathematical method for assessing the helpfulness and quality of medical guidelines.
- To analyze the '2020 European Society of Cardiology Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease Guideline' (SCE-guideline) as a proof of concept.
- To introduce a 'certainty index' (CI) for quantifying the quality of evidence supporting GL recommendations.
Main Methods:
- Mathematical analysis of 'Classes of Recommendations' (CLASS) and 'Levels of Evidence' (LEVEL) from the SCE-guideline (n=159).
- Calculation of a certainty index (CI: -1 to +1) based on LEVEL areas under CLASS.
- Frequency analysis of CLASS and LEVEL to determine the distribution of recommendation types and evidence quality.
Main Results:
- The SCE-guideline showed a high proportion of CLASS I ('to do') and CLASS III ('not to do') recommendations (52.2%).
- The most frequent LEVEL was C (41.2-83.8%), indicating a generally lower quality of scientific evidence.
- The calculated certainty index (CI) for the SCE-guideline was +0.57, reflecting 78.4% certainty and 21.6% uncertainty.
Conclusions:
- The developed mathematical analysis provides an objective 'quality control' tool for medical guidelines.
- The SCE-guideline offers practical recommendations but relies on evidence of varying, often lower, quality.
- The certainty index facilitates the assessment, comparison, and improvement of future medical guidelines.
Abstract:
Background/Objectives: The recommendations included in medical guidelines (GLs) provide important help to medical professionals for making clinical decisions regarding the diagnosis and treatment of various diseases. However, there are no systematic methods to measure the helpfulness of GLs. Thus, we developed an objective assessment of GLs which indicates their helpfulness and quality. We hypothesized that a simple mathematical analysis of 'Recommendations' and 'Evidence' would suffice. Methods: As a proof of concept, a mathematical analysis was conducted on the '2020 European Society of Cardiology Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease Guideline' (SCE-guideline). First, the frequencies of Classes of Recommendations (CLASS) and the Levels of Evidence (LEVEL) (n = 159) were analysed. Then, LEVEL areas under CLASS were calculated to form a certainty index (CI: -1 to +1). Results: The frequency of CLASS I ('to do') and CLASS III ('not to do') was relatively high in the SCE-guideline (52.2%). Yet, the most frequent LEVEL was C (41.2-83.8%), indicating only a relatively low quality of scientific evidence in the SCE-guideline. The SCE-guideline showed a relatively high CI (+0.57): 78.4% certainty and 21.6% uncertainty. Conclusions: The SCE-guideline provides substantial help in decision making through the recommendations (CLASS), while the supporting evidence (LEVEL) in most cases is of lower quality. This is what the newly introduced certainty index showed: a tool for 'quality control' which can identify specific areas within GLs, and can promote the future improvement of GLs. The newly developed mathematical analysis can be used as a Guideline for the Guidelines, facilitating the assessment and comparison of the helpfulness and quality of GLs.
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