Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization

Article Abstract:

Despite enormous energies invested in authoring clinical practice guidelines, the quality of individual guidelines varies considerably. The Conference on Guideline (COGS) was convened in April 2002 to define a standard for guideline reporting that would promote guideline quality and facilitate implementation. Twenty-three people with expertise and experience in guideline development, dissemination, and implementation participated. A list of candidate guideline components was assembled from the Institute of Medicine Provisional Instrument for Assessing Clinical Guidelines, the National Guideline Clearinghouse, the Guideline Elements Model, and other published guideline models. In a 2-stage modified Delphi process, panelists first rated their agreement with the statement that "[item name] is a necessary component of practice guidelines" on a 9-point scale. An individualized report was prepared for each panelist; the report summarized the panelist's rating for each item and the median and dispersion of rankings of all the panelists. In a second round, panelists separately rated necessity for validity and necessity for practical application. Items achieving a median rank of 7 or higher on either scale, with low disagreement index, were retained as necessary guideline components. Representatives of 22 organizations active in guideline development reviewed the proposed items and commented favorably. Closely related items were consolidated into 18 topics to create the COGS checklist. This checklist provides a framework to support more comprehensive documentation of practice guidelines. Most organizations that are active in guideline development found the component items to be comprehensive and to fit within their existing development methods.

Product standards, safety, & recalls, Standards, Conferences, meetings and seminars, Practice guidelines (Medicine), Author Abstract

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The periodic health examination provided to asymptomatic older women: an assessment using standardized patients

Article Abstract:

Physicians may vary widely in their performance during periodic health examinations for older asymptomatic women. These types of examinations include a physical examination and different types of cancer prevention services. Actresses portraying a 55-year-old asymptomatic women visited 59 primary care physicians who were participating in a study of early detection and prevention of cancer. The performance of 14 different physical examination components varied widely. Ninety-eight percent of the physicians measured patient blood pressure, but only 5% assessed vibratory sense. The provision of 10 services recommended by the National Cancer Institute also varied. Eighty-nine percent of the women were advised to have a mammogram, but only 16% were advised to reduce dietary fat. The time spent with each patient varied between five minutes and one hour.

Care and treatment, Management, Aged women, Elderly women, Periodic health examinations

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Mammographic screening for women aged 40 to 49 years: the primary care practitioner's dilemma

Article Abstract:

Recent evidence suggests that mammographic screening of women aged 40 to 49 years may reduce the risk of death from breast cancer. The National Cancer Institute (NCI) has recently dropped its previous recommendation that women in the 40 to 49 year age range be routinely screened for breast cancer. It continues to recommend routine screening for women aged 50 to 64. The NCI may have changed its previous recommendation because of a perceived need to limit costs. Primary care doctors may need to decide for themselves what they recommend for women in their practices. Some doctors think the evidence of benefit for women in the 40 to 49 group is not strong enough. Others think it may be better to err on the side of routine screening for younger women.

Evaluation, Mammography, Middle aged women

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