Specialty Society Guidelines Must Evolve to Improve Save

The current JAMA issue examines the process and potential flaws of society clinical practice guidelines -a timely commentary as we await the 2015 ACR RA treatment guidelines first presented at the 2014 ACR meeting in Boston and slated for upcoming publication in Arthritis & Rheumatology.

Drs. Classen and Mermel recognize the importance and need for society-generated clinical practice guidelines, but note the complexity of process may miss the mark by not being clinically practical or easily implemented. Society guideline committees often have development cycles so protracted that guidelines may be outdated by the time they are published. Although many have called for the National Institutes of Health or Agency for Healthcare Research and Quality to develop guidelines, most clinical practice guidelines are currently produced by specialty societies.

The Institute of Medicine (IOM) has stated that the current approach to CPG development is flawed and fundamentally needs a new approach. There are issues regarding the degree of scientific evidence, the weight of “expert consensus”, transparency of methods used by the writing group, challenges regarding conflict of interest (COI), and guideline inconsistency from different societies working in the same area.

There are no standards for specialty societies to develop CPGs. Different societies employ different processes and have disparate budgets for what can be a long or expensive undertaking. The IOM has published recommendations for CPGs, yet the IOM recommendations are based on consensus, and there are no data that the process recommended by IOM produces superior guidelines.

Newer models for CPG development should include all the stakeholders, including patients. They need to have rigor, transparency and answer practical questions with guidance that is meaningful and has measureable outcomes. The goal of specialty society CPGs should be to improve the quality and safety of care and reduce cost.