Updating clinical guidelines
Background Clinical practice guidelines (CPGs) have become increasingly popular, and the methodology to develop guidelines has evolved enormously.However, little attention has been given to the updating process, in contrast to the appraisal of the available literature.We aimed to examine (1) the completeness of reporting the updating process in CGs and (2) the inter-observer reliability of Check Up.We conducted a systematic assessment of the reporting of the updating process in a sample of updated CGs using Check Up.Presentation and justification items at recommendation level (respectively reported by 27 and 38% of the CGs) and the methods used for the external review and implementing changes in practice were particularly poorly reported (both reported by 38% of the CGs).CGs developed by a European or international institution obtained a statistically significant higher overall score compared to North American or Asian institutions (The reporting of updated CGs varies considerably with significant room for improvement.We calculated the median score per item, per domain, and overall, converting scores to a 10-point scale.Multiple linear regression analyses were used to identify differences according to country, type of organisation, scope, and health topic of updated CGs.
According to the scale proposed by Landis and Koch, the degree of agreement between 0.00 and 0.20 was considered poor, from 0.21 to 0.40 fair, from 0.41 to 0.60 moderate, from 0.61 to 0.80 substantial, and from 0.81 to 1.00 almost perfect [).
We calculated the intraclass coefficient (ICC) and 95% confidence interval (95% CI) for domains and overall score. The median domain score on a 10-point scale for presentation was 5.8 (range 1.7 to 10), for editorial independence 8.3 (range 3.3 to 10), and for methodology 5.7 (range 0 to 10).
The median overall score on a 10-point scale was 6.3 (range 3.1 to 10).
We conducted an international survey to identify current practices in CPG updating and explored the need to standardize and improve the methods.
Methods We developed a questionnaire (28 items) based on a review of the existing…
Check Up consists of three domains: (1) presentation of the updated CG (6 items), (2) editorial independence (3 items), and (3) the methodology of the updating process (7 items).