American College of Chest Physicians Evidence-Based Guidelines – The Next Generation
Considering resource use and evolution to a single grading system
Michael H. Baumann, MD, MS, FCCP and David D. Gutterman, MD, FCCP
Abstract
The American College of Chest Physicians (ACCP) has successfully provided high-quality clinical practice guidelines for over 10 years. Over the last 6 years, a concerted effort has been supervised by the ACCP Health and Science Policy Committee to ensure that these documents move as close as possible to an evidence-based platform. The reader is invited to visit the Health and Science Policy Committee Web site to learn more about the process of the ACCP in developing evidence-based guidelines.1 Some evidence-based guideline publication topics include lung cancer,2 pulmonary arterial hypertension,3 antithrombotic and thrombolytic therapy,4 aerosol therapy,5 atrial fibrillation after coronary arterial bypass grafting,6 and cough.7 A forthcoming evidence-based guideline will highlight occupational asthma.
All of these documents provide the best available evidence-based recommendations for the particular clinical topics at hand. However, perusal of the guidelines reveals the use of varying custom-derived grading systems on which the recommendations are based. This variability reflects the specific needs of each writing panel, but as a result the repertoire of the different grading systems can be bewildering and confusing to clinicians often wishing to compare the level of recommendations between different documents. Recognizing this problem, the ACCP financed a thorough review of our evidence grading system with the goal of developing and adopting a single grading system for all future ACCP evidence-based guidelines. In March 2005, a comprehensive review occurred at ACCP headquarters and continued off-site for several months. A new grading system was developed and was subsequently approved by the ACCP Board of Regents. This grading system arose as an adaptation of a preexisting grading methodology,8 but this adaptation is not an ACCP endorsement of that or any other existing grading system. The newly adopted ACCP system is found in this month’s issue of CHEST9 (pages 174). The consistent utilization of this grading system across all future ACCP evidence-based guidelines will provide consistency and clarity from one evidence-based guideline to another, thereby minimizing the confusion among clinicians adopting the recommendations. Furthermore, it can be “translated” to prior ACCP grading systems and to several other widely used grading systems, facilitating comparisons among guideline recommendations.
Guideline Ranking & Disclaimer
Rank | Definition |
|---|---|
| 1 | This guideline is new and represents the best available evidence at this time. It will be reviewed on an annual basis to determine if it remains current. |
| 2 | This guideline is reviewed on an annual basis and there have been new studies published since the guideline was developed. However, the Health and Science Policy (HSP) Committee determined that these studies are not sufficient to warrant changing the guideline at this time. The information contained in this guideline provides the user with the best evidence available at the time the guideline was published. Readers are encouraged to search the current literature as a supplement to using this guideline. |
| 3 | This guideline is reviewed on an annual basis. The HSP Committee determined that new studies have been published that warrant an update of the (fill in) chapter/section of this practice guideline. The HSP Committee also determined that the remainder of the chapters/sections does not require updating and these recommendations remain current. |
| 4 | This guideline is reviewed on an annual basis. The HSP Committee determined that new data are available that are sufficient to potentially change guideline recommendations and a full revision is warranted. |
| 5 | This guideline has been reviewed on an annual basis. The HSP Committee has decided it is outdated; however, it has been retained for historical and/or educational purposes. These guidelines should be used with caution for clinical decision-making purposes. |
The evidence-based practice guidelines published by The American College of Chest Physicians (“ACCP”) incorporate data obtained from a comprehensive literature review of the most recent studies available at the time of publication. Guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any specific condition. Furthermore, guidelines may not be complete or accurate because new studies that may have become available late in the process of guideline development may not be incorporated into any particular guideline before it is disseminated. ACCP and its officers, regents, governors, executive committee, members and employees (the “ACCP Parties”) disclaim all liability for the accuracy or completeness of a guideline, and disclaim all warranties, express or implied. Guideline users always are urged to seek out newer information that might impact the diagnostic and treatment recommendations contained within a guideline. The ACCP Parties further disclaim all liability for any damages whatsoever (including, without limitation, direct, indirect, incidental, punitive, or consequential damages) arising out of the use, inability to use, or the results of use of a guideline, any references used in a guideline, or the materials, information, or procedures contained in a guideline, based on any legal theory whatsoever and whether or not there was advice of the possibility of such damages.
