Guideline organizations' guidance documents paper 11: quality assurance and improvement in guideline development

The integration of quality assurance and improvement (QAI) into all steps of guideline development can promote the measurability and relevance of guidelines to real-world practice. Our objective was to describe QAI processes as described in guidance documents of guideline-producing organizations.

We conducted a comprehensive search in 2021, and updated it in 2024, to identify guidance documents publicly available by guideline-producing organizations. We abstracted data based on the items of the Guidelines International Network (GIN)-McMaster Checklist Extension for Quality Assurance and Quality Improvement (published in 2022) as well as any additional items that emerged from our data. Two authors independently assessed the eligibility of identified organizations and abstracted data on the organization's characteristics, QAI processes in guideline development, and on terminology used to refer to QAI elements (eg, quality indicators, performance measures). We analyzed categorical variables using frequencies and percentages and summarized the findings in textual and tabular formats.

Sixty-nine of 133 guideline-producing organizations (about half) addressed QAI either as a brief mention (57%), a section in a document (33%), or a dedicated document (10%). Guideline-producing organizations used inconsistent terminology when referring to QAI elements. The most frequently addressed QAI items were predefining the process to select final quality measures (26%), the need for project subgroups to work on QAI (25%), and identifying the individuals of the subgroups (23%). The least addressed items were considering institutional conflicts of interest (1%), providing clarity on accountability to making the changes in quality indicators (3%), and developing/adopting a standardized reporting format (4%). Some QAI items were not addressed at all, including determining the QAI scheme scope, perspective, and pilot-testing of indicators with target users.

The coverage of the items of the GIN-McMaster GDC QAI extension varies across the guidance documents of guideline-producing organizations. Also, the organizations used inconsistent terminology when referring to QAI elements.