Download The Need for Collaboration

How to Overcome Barriers and
Develop Collaborative Guidelines
Amir Qaseem, MD, PhD, MHA, FACP
Chair, Guidelines International Network
Director, Clinical Policy, American College of Physicians
Conflicts of Interest


Financial: None
Non-financial:
Guidelines International Network (G-I-N)
 Institute of Medicine (IOM)
 Centers for Disease Control and Prevention
(CDC)
 National Quality Forum (NQF)
 American Quality Alliance (AQA)
 DECIDE project

The Need for Collaboration
(Prostate Cancer Screening)

ACPM concludes that there is insufficient
evidence to recommend routine population
screening with digital rectal exam or prostate
specific antigen.
 ACS recommends that prostate cancer
screening should not occur without an informed
decision-making process. Men at average risk
should receive this information beginning at age
50 years. Men in higher risk groups should
receive this information before age 50 years.
ACPM American College of Preventive Medicine
ACS American Cancer Society
The Need for Collaboration
(Prostate Cancer Screening)


AUA recommends that early detection and
risk assessment of prostate cancer should be
offered to asymptomatic men 40 years of age
or older who wish to be screened and have
an estimated life expectancy of more than 10
years.
USPSTF recommends against PSA-based
screening for prostate cancer.
AUA American Urological Association
USPSTF United States Preventive Services Task Force
The Need for Collaboration
(Prostate Cancer Screening)


EAU recommends the decision to undergo
early PSA testing should be a shared
decision between the patient and his
physician based on information balancing its
advantages and disadvantages.
CCA recommends insufficient evidence for
population based screening.
EAU European Association of Urology
CCA Cancer Council Australia and Andrology Australia
Screening for Colorectal Cancer:
Qaseem et al: Ann Intern Med.
2012;156(5):378-386
2. I would recommend this guideline for use.
(please respond: yes, yes with modifications, or no)
4 yes
2 yes with modifications
1 no
2 yes
7 yes
3 yes with modifications
2 no
7 no
The Need for Collaboration

Target Audience

Clinicians (Advanced Practice Nurses, Allied Health
Personnel, Nurses, Physicians)
 Patients
 Health Insurers
 Policy Makers
Process of Collaborative Guideline
Development

Topic selection & key questions
 Identification of relevant stakeholders
 Establishing the ground rules
Establish the Ground Rules for
Collaboration
Financial Support
 Dissemination
 Guideline Development Group
 Conflicts of Interest

Memorandum of Understanding (MOU)
 Timeline

Establish the Ground Rules for
Collaboration

Evidence and outcomes
KQ & clinical outcomes
 What kind of evidence base will be used?
 How will recommendations be developed?
 What grading system will be used?
 What decision making process will be used?
 How will you deal with disagreement on evidence
or recommendations?
 What processes need to be followed for each
society to approve the guideline?

Benefits of Collaboration




Reduce the number of guidelines and
potentially differing recommendations on the
same topic (harmonization)
Conserve resources
Incorporate more stakeholders in the
development process, which results in a
better and more widely accepted guideline
Reach a larger, more diverse audience
Barriers & Hurdles



Longer time to complete the guideline
Compromise on methods/outcomes
Challenge to arrive at consensus for difficult
topics
Many Successful Examples…

Diagnosis & Management of Patients with Stable Ischemic Heart
Disease (American College of Physicians/American College of
Cardiology Foundation/American Heart Association/ American
Association for Thoracic Surgery/ Preventive Cardiovascular
Nurses Association)

Diagnosis and Management of Stable Chronic Obstructive
Pulmonary Disease (American College of Physicians, American
College of Chest Physicians, American Thoracic Society, and
European Respiratory Society)

Current Pharmacologic Treatment of Dementia (American
College of Physicians and American Academy of Family
Physicians)

Diagnosis and Treatment of Low Back Pain (American College of
Physicians and American Pain Society *Veterans
Affairs/Department of Defense)