The clinical efficacy assessment program of the American College of Physicians

The experience of the American College of Physicians (ACP) in evaluating the clinical literature and publishing clinical guidelines spans more than a decade. The ACP uses an evidence-based method for the development of clinical practice guidelines for diagnostic technologies and treatments. The approach of the Clinical Efficacy Assessment Program (CEAP) involves collation, methodologic review, and analysis of the clinical literature. The process focuses on the safety, contraindications, efficacy, limitations, and cost of diagnostic technologies or treatments. To ensure a balanced perspective of the evidence, methodologic and content experts cooperate to prepare a summary paper. Strengths of this evidence-based approach include: (1) focus on the needs of practicing internists; (2) identification of all pertinent clinical literature; (3) integration of expert opinion when literature is inadequate; (4) recommendations based on high-quality scientific evidence; (5) preparation of conservative guidelines when evidence is lacking; and (6) reevaluation of past guidelines as new evidence becomes available. Limitations of the process include: (1) access only to published research; (2) use of criteria for scientific quality that are not standardized across projects; (3) published recommendations based on small numbers of high-quality research products; (4) compromise with expert opinion when evidence is limited; and (5) ad hoc management of conflict between experts when scientific evidence is sparse. The process produces credible recommendations that may improve physician knowledge and acceptance of practice guidelines.