acog clinical practice guidelines: systematic reviews: evidence … · 2018-12-18 · •over 20...
TRANSCRIPT
Systematic Reviews: Evidence to Advance Decision Making
Nancy O’Reilly, MHS, PMPSenior Director, Gynecologic Practice and WPSI
American College of Obstetricians and Gynecologists November 1, 2018
• First Practice Bulletin published in 1998
• 200 titles published since inception
• Current Practice Bulletins ◦ 45 Obstetric ◦ 35 Gynecology
• Methodology summary listed on published document
• Posted on ACOG website
• Process undergoing update, so new process will be published and posted on website
• Authors and Chairs required to have no related financial conflicts
• Members with potential conflicts have restrictions on input and voting
• Conflicts for members and authors updated, evaluated and disclosed to committee throughout process
• No external funding supports guideline development work
• Standing committees 1) Gynecology and 2) Obstetrics
• 8-10 Ob-Gyn members with methodologic expertise
• 2 public members
• Collaboration in document development ◦ Ob-Gyn subspeciality
organizatons ◦ Other Medical Specialty
Societies
•Evidence Review ◦ In-house medical librarians ◦ MEDLINE database, Cochrane Library, Guidelines from
other organizations or institutions ◦ Based on PICO elements identified in outline
•Organized by level of evidence: o Systematic Reviews* o Randomized Controlled Trials o Observational Studies o Organizational Guidelines
• Based on previous USPSTF methodology
• Evidence identified based on inclusion/ exclusion criteria
• Recommendations directly linked to evidence
• Evidence maps to review supporting evidence quality and confirm recommendation
• Recommendations: ◦ Level A – good, consistent ◦ Level B – limited or inconsistent ◦ Level C – expert opinion
• Clinical Document Review Panel ◦ Content review ◦ Ob Panel and Gyn
Panel ◦ 8 members each ◦ Previous Practice
committee membership ◦ Written response to
comments
• Executive Board ◦ Review by full
Executive Board ◦ Board leadership,
representatives from12 ACOG Districts; partner organizations ◦ Primarily policy
review
• Published in Obstetrics and Gynecology • Full guideline reviewed every 18-24 months
at in-person meeting • Horizon scan for new evidence on-going for
each topic • Updated when new clinical data would
prompt change to recommendation(s)
• Engaged with AHRQ EPCs since 1998◦ Nomination of topics ◦ Participation in Technical Expert Panels ◦ Expert review of final reports
• Partner with several EPCs including:◦ Duke ◦ UNC/RTI ◦ Vanderbilt ◦ OHSU
• Review EPC reports as partner organization toUSPSTF
• Collaboration with EPCs allows identification and evaluation of most important clinical issues
• Clinical experts/authors involved at each stage of S/R development
• Input at PICO development stage • Prioritized as highest level of evidence to develop
accurate recommendations • Serves as the anchor to our clinical practice
guidelines
• Over 20 Practice Bulletin titles based on EPC Systematic Reviews
• Practice Bulletin #137 Gestational Diabetes Mellitus (2013) • Practice Bulletin # 131 –Screening for Cervical Cancer (2013) • Practice Bulletin #129 – Osteoporosis (2012) • Practice Bulletin #107 Induction of Labor (2009) • Practice Bulletin #105 – Bariatric Surgery and Pregnancy
(2009) • Practice Bulletin #96 – Alternatives to Hysterectomy in
Management of Leiomyomas (2008)
►Additional topics in process
• Committee Opinions • CO 561 -Nonmedically Indicated Early-Term Deliveries (2013) • CO 559 - Cesarean Delivery on Maternal Request (2013) • CO 372 - The Role of Cystourethroscopy in the Generalist
Obstetrician-Gynecologist Practice (2007)
• Books and special projects • Hypertension in Pregnancy Task Force Report (2013) • Induction of Labor - Patient Safety Checklist (2011) • Neonatal Encephalopathy and Cerebral Palsy-Defining the
Pathogenesis and Pathophysiology (2003)