Why Should I Appraise Clinical Practice Guidelines?

You should evaluate every source you use to inform your expert opinions and decisions-- even if they aren't clinical practice guidelines. The decisions you make in clinical situations based on practice guidelines impact patient lives and the quality of healthcare you provide. Luckily, there are frameworks already in place that you can use to assess the quality of evidence in practice guidelines. Browse the frameworks below to determine the validity of the guidelines you are interested in using. 

Clinical Practice Guidelines We Can Trust

The National Academy of Medicine (previously the Institute of Medicine) published Clinical Guidelines We Can Trust in 2011 that propose standards to measure practice guidelines in order to ensure an evidence-based practice approach to medicine. They say:

 "To be trustworthy, a guideline should:

• be based on a systematic review of the existing evidence;
• be developed by a knowledgeable, multidisciplinary panel of experts and representatives from key affected groups;
• consider important patient subgroups and patient preferences, as appropriate; 
• be based on an explicit and transparent process that minimizes distortions, biases, and conflicts of interest; 
• provide a clear explanation of the logical relationships between alternative care options and health outcomes, and provide ratings of both the quality of evidence and the strength of recommendations; and 
• be reconsidered and revised as appropriate when important new evidence warrants modifications of recommendations." 

The NEATS Instrument can be used to evaluate practice guidelines.

GUIDE-M

The Guideline Implementability for Decision Excellence Model (GUIDE-M) aims to optimize the implementability of practice guidelines for every stakeholder involved (developers, users, and researchers). It addresses:

• Content Developement
  • Is it comprehensive?
  • Is it credible?
  • Are there competing interests?
• Content Creation
  • Is the evidence synthesized?
  • Is context provided to ensure applicability and interoperability in different clinical situations?
• Content Communication
  • Is the language of the document clear and easy to understand?
  • Does the format of the guideline detract from the argument?

AGREE II

The Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument can be used to assess practice guidelines, but does not address all parts of the clinical practice guideline definition from the IOM. With this tool, you will rate the following items:

• Scope and Purpose
• Stakeholder Involvement
• Rigor of Development
• Clarity of Presentation
• Applicability
• Editorial Independence