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Development of the AHCPR-sponsored heart failure guideline: methodologic and procedural issues
The Joint Commission Journal on Quality Improvement
|October 1, 1994
Summary
Developing clinical practice guidelines for heart failure management involved a complex consensus process. Frequent expert input and peer review ensured broad clinical acceptance of the final recommendations.
Area of Science:
- Health Services Research
- Clinical Practice Guidelines
- Cardiology
Background:
- RAND Corporation contracted for the Agency for Health Care Policy and Research (AHCPR)-sponsored guideline.
- Guideline focused on managing heart failure due to left-ventricular systolic dysfunction.
Purpose of the Study:
- To outline the complex process of developing clinical practice guidelines.
- To detail methods for achieving consensus on practice recommendations.
Main Methods:
- A 16-member panel engaged in discussions to reach consensus on practice recommendations.
- A draft algorithm served as a central tool, iteratively revised throughout the process.
- National experts were consulted early and frequently to address controversial issues.
Main Results:
- Key decisions involved focusing the guideline, rating evidence strength, and linking evidence to recommendations.
- Consensus was achieved even in the absence of data or with differing opinions.
- The process facilitated conclusions on complex issues like coronary artery revascularization evaluation.
Conclusions:
- The guideline development was a complex and painstaking process.
- Frequent peer review and expert consultation contributed to a widely acceptable guideline.
- The developed guideline is expected to achieve broad clinical and geographic acceptance.