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Quality and methods of developing practice guidelines

BACKGROUND: It is not known whether there are differences in the quality and recommendations between evidence-based (EB) and consensus-based (CB) guidelines. We used breast cancer guidelines as a case study to assess for these differences. METHODS: Five different instruments to evaluate the quality...

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Autores principales: Cruse, Hugh, Winiarek, Magdalena, Marshburn, Jan, Clark, Otavio, Djulbegovic, Benjamin
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2002
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC65517/
https://www.ncbi.nlm.nih.gov/pubmed/11825346
http://dx.doi.org/10.1186/1472-6963-2-1
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author Cruse, Hugh
Winiarek, Magdalena
Marshburn, Jan
Clark, Otavio
Djulbegovic, Benjamin
author_facet Cruse, Hugh
Winiarek, Magdalena
Marshburn, Jan
Clark, Otavio
Djulbegovic, Benjamin
author_sort Cruse, Hugh
collection PubMed
description BACKGROUND: It is not known whether there are differences in the quality and recommendations between evidence-based (EB) and consensus-based (CB) guidelines. We used breast cancer guidelines as a case study to assess for these differences. METHODS: Five different instruments to evaluate the quality of guidelines were identified by a literature search. We also searched MEDLINE and the Internet to locate 8 breast cancer guidelines. These guidelines were classified in three categories: evidence based, consensus based and consensus based with no explicit consideration of evidence (CB-EB). Each guideline was evaluated by three of the authors using each of the instruments. For each guideline we assessed the agreement among 14 decision points which were selected from the NCCN (National Cancer Comprehensive Network) guidelines algorithm. For each decision point we recorded the level of the quality of the information used to support it. A regression analysis was performed to assess if the percentage of high quality evidence used in the guidelines development was related to the overall quality of the guidelines. RESULTS: Three guidelines were classified as EB, three as CB-EB and two as CB. The EB guidelines scored better than CB, with the CB-EB scoring in the middle among all instruments for guidelines quality assessment. No major disagreement in recommendations was detected among the guidelines regardless of the method used for development, but the EB guidelines had a better agreement with the benchmark guideline for any decision point. When the source of evidence used to support decision were of high quality, we found a higher level of full agreement among the guidelines' recommendations. Up to 94% of variation in the quality score among guidelines could be explained by the quality of evidence used for guidelines development. CONCLUSION: EB guidelines have a better quality than CB guidelines and CB-EB guidelines. Explicit use of high quality evidence can lead to a better agreement among recommendations. However, no major disagreement among guidelines was noted regardless of the method for their development.
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spelling pubmed-655172002-02-14 Quality and methods of developing practice guidelines Cruse, Hugh Winiarek, Magdalena Marshburn, Jan Clark, Otavio Djulbegovic, Benjamin BMC Health Serv Res Research Article BACKGROUND: It is not known whether there are differences in the quality and recommendations between evidence-based (EB) and consensus-based (CB) guidelines. We used breast cancer guidelines as a case study to assess for these differences. METHODS: Five different instruments to evaluate the quality of guidelines were identified by a literature search. We also searched MEDLINE and the Internet to locate 8 breast cancer guidelines. These guidelines were classified in three categories: evidence based, consensus based and consensus based with no explicit consideration of evidence (CB-EB). Each guideline was evaluated by three of the authors using each of the instruments. For each guideline we assessed the agreement among 14 decision points which were selected from the NCCN (National Cancer Comprehensive Network) guidelines algorithm. For each decision point we recorded the level of the quality of the information used to support it. A regression analysis was performed to assess if the percentage of high quality evidence used in the guidelines development was related to the overall quality of the guidelines. RESULTS: Three guidelines were classified as EB, three as CB-EB and two as CB. The EB guidelines scored better than CB, with the CB-EB scoring in the middle among all instruments for guidelines quality assessment. No major disagreement in recommendations was detected among the guidelines regardless of the method used for development, but the EB guidelines had a better agreement with the benchmark guideline for any decision point. When the source of evidence used to support decision were of high quality, we found a higher level of full agreement among the guidelines' recommendations. Up to 94% of variation in the quality score among guidelines could be explained by the quality of evidence used for guidelines development. CONCLUSION: EB guidelines have a better quality than CB guidelines and CB-EB guidelines. Explicit use of high quality evidence can lead to a better agreement among recommendations. However, no major disagreement among guidelines was noted regardless of the method for their development. BioMed Central 2002-01-11 /pmc/articles/PMC65517/ /pubmed/11825346 http://dx.doi.org/10.1186/1472-6963-2-1 Text en Copyright © 2002 Cruse et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
spellingShingle Research Article
Cruse, Hugh
Winiarek, Magdalena
Marshburn, Jan
Clark, Otavio
Djulbegovic, Benjamin
Quality and methods of developing practice guidelines
title Quality and methods of developing practice guidelines
title_full Quality and methods of developing practice guidelines
title_fullStr Quality and methods of developing practice guidelines
title_full_unstemmed Quality and methods of developing practice guidelines
title_short Quality and methods of developing practice guidelines
title_sort quality and methods of developing practice guidelines
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC65517/
https://www.ncbi.nlm.nih.gov/pubmed/11825346
http://dx.doi.org/10.1186/1472-6963-2-1
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