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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

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Page 1: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

How to Overcome Barriers and Develop Collaborative Guidelines

Amir Qaseem, MD, PhD, MHA, FACPChair, Guidelines International Network

Director, Clinical Policy, American College of Physicians

http://www.g-i-n.net/activities/g-i-n-na
Page 2: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

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

http://www.g-i-n.net/activities/g-i-n-na
Page 3: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

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 MedicineACS American Cancer Society

http://www.g-i-n.net/activities/g-i-n-na
Page 4: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

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 AssociationUSPSTF United States Preventive Services Task Force

http://www.g-i-n.net/activities/g-i-n-na
Page 5: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

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

http://www.g-i-n.net/activities/g-i-n-na
Page 6: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

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 yes2 yes with modifications1 no

2 yes3 yes with modifications2 no

7 yes 7 no

http://www.g-i-n.net/activities/g-i-n-na
Page 7: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

The Need for Collaboration Target Audience

Clinicians (Advanced Practice Nurses, Allied Health Personnel, Nurses, Physicians)

Patients Health Insurers Policy Makers

http://www.g-i-n.net/activities/g-i-n-na
Page 8: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

Process of Collaborative Guideline Development

Topic selection & key questions Identification of relevant stakeholders Establishing the ground rules

http://www.g-i-n.net/activities/g-i-n-na
Page 9: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

Establish the Ground Rules for Collaboration Financial Support Dissemination Guideline Development Group Conflicts of Interest

Memorandum of Understanding (MOU) Timeline

http://www.g-i-n.net/activities/g-i-n-na
Page 10: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

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?

http://www.g-i-n.net/activities/g-i-n-na
Page 11: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

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

http://www.g-i-n.net/activities/g-i-n-na
Page 12: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

Barriers & Hurdles

Longer time to complete the guideline Compromise on methods/outcomes Challenge to arrive at consensus for difficult

topics

http://www.g-i-n.net/activities/g-i-n-na
Page 13: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical

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)

http://www.g-i-n.net/activities/g-i-n-na
Page 14: How to Overcome Barriers and Develop Collaborative Guidelines Amir Qaseem, MD, PhD, MHA, FACP Chair, Guidelines International Network Director, Clinical
http://www.g-i-n.net/activities/g-i-n-na

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