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Functions and Processes

Definitions and Explanations

Evidence-Based Guidelines

The ACCP defines evidence-based clinical practice guidelines as documents containing rigorously developed and graded recommendations, algorithms, and other information to assist clinical decision-making for specific conditions based on a verifiable systematic review of the literature from peer-reviewed journals. The quality of evidence and strength of recommendations are formally graded following the ACCP grading system. [3a8] Although written by experts who have been carefully selected to represent expertise in the relevant topic area, multiple medical or surgical specialties, and diversity of gender and geography, the recommendations must be based on the results of a formal evidence review. Clinical practice guidelines undergo formal peer review and approval by the HSP Committee and ACCP Board of Regents prior to publication. Development of evidence-based guidelines falls under the formal oversight of the HSP Committee. The appropriate ACCP NetWorks are requested to review the guidelines for content, including relevant literature and appropriately derived recommendations and grading.

Evidence-Based Guidelines - Suggested Reading

  1. Baumann MH, Gutterman D, Lewis SZ. ACCP evidence based guideline development: a successful and transparent approach addressing conflict of interest, funding, and patient-centered recommendations. Chest 2007; 132:1015-1024

  2. Guyatt G, Gutterman D, Baumann M, et al. Grading strength of recommendations and quality of evidence in clinical practice guidelines: a report from the American College of Chest Physicians task force. Chest 2006; 129:174-181

  3. Guyatt G, Baumann M, Pauker S, et al. Addressing resource allocation in recommendations from clinical practice guidelines: suggestions from the ACCP task force. Chest; 2006; 129:182-187

  4. Field MJ, Lohr KN, eds. Guidelines for clinical practice: from development to use. Washington, DC: National Academy Press, 1990

  5. Field MJ, Lohr KN, eds. Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press, 1990

  6. Grol R, Wensing M. What drives change? Barriers to and incentives for achieving evidence-based practice. MJA 2004; 180:S57-S60

  7. Shojania JG, Grimshaw JM. Evidence-based quality improvement: the state of the science. Health Affairs. 2005; 24:138-150

  8. Straus SE, Richardson WS, Glasziou P, et al, eds. Evidence-based medicine: how to practice and teach EBM. 3rd ed. London, UK: Churchill-Livingston, 2005

Since 2004, non-evidence consensus-based statements, systematic reviews, and surveys have been transferred to the ACCP NetWorks and Institutes for oversight.


Consensus Statements

The ACCP defines a consensus statement as a document representative of the collective opinion of an expert panel. The opinions expressed in the statement do not necessarily reflect a formal evidence review and are not developed in accordance with the process outlined for evidence-based clinical practice guidelines. The following caveats apply for the development of ACCP consensus statements:

  1. The terms "recommendation," "evidence-based," and "guideline" should not be used in the context of consensus statements. Findings of a consensus panel are indicated as "opinions" or "suggestions."
  2. Consensus panels should be encouraged to include a methods section on how consensus was achieved, either formally or informally.
    1. Whether included in the methods section or (if no methods section) in the introduction, explicit information should be provided to the reader that the information contained in the document is based on consensus and expert opinion.
  3. Explicit language should convey that the information contained in the document is based on consensus and expert opinion.
  4. The document will explicitly state that the opinions expressed in the document should not be used for performance measurement or for competency purposes since they are not based on systematically reviewed evidence.
  5. Consensus statements can be developed by NetWorks or ACCP Institutes as specific projects.
  6. Consensus documents should undergo Board of Regents review prior to publication.

Consensus Statements - Suggested Reading

  1. McMurray AR. Three decision-making aids: brainstorming, nominal group, and Delphi technique. J Nurs Staff Develop 1994; 10:62-65

  2. Fink A, Kosecoff J, Chassin M, et al. Consensus methods: characteristics and guidelines for use. Am J Pub Health 1984; 75:979-983

  3. Ashton CM, Kuykendall DH, Johnson ML, et al. A method of developing and weighting explicit process of care criteria for quality assessment. Medical Care 1994; 32:755-770

  4. Allen J, Dyos J, Jones M. Building consensus in healthcare: a guide to using the nominal group technique. Br J Community Nurs 2004; 9:110-114

  5. Baker J, Lovell K, Harris N. How expert are the experts? An exploration of the concept of ‘expert’ within Delphi panel techniques. Nurse Res 2006; 14:59-70

Systematic Reviews and Surveys

The ACCP recognizes that there may be times when a review of the literature with or without formal metaanalysis could provide valuable information to the readership. These research papers should provide a formal methods section describing the literature review and analysis. These types of projects may also include well-designed and tested surveys on clinical or practice issues. Independent reviews and surveys are not associated with guideline development and do not fall under the purview of the HSP Committee.

Systematic Reviews - Suggested Reading

  1. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17:1-12

  2. Ioannidis JP, Lau J. Pooling research results: benefits and limitations of meta-analysis. Jt Comm J Qual Improv 1999; 25:462-469

  3. Egger M, Smith GD, Sterne JA. Uses and abuses of meta-analysis. Clin Med 2001 ;1:478-484

  4. Systematic reviews in health care: meta-analysis in context. 2nd ed. M Eggger, GD Smith, DG Altman, Eds. BMJ. 2001 London, UK

  5. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analysis of randomized control trials: the QUOROM statement. Br J Surg 2002; 87:1448-1454

  6. Rosenfeld RM. Meta-analysis. ORL J Otorhinolaryngol Rel Spec 2004; 66:186-195

Survey Techniques - Suggested Reading

  1. Fink A, Kosecoff J. How to conduct surveys: a step-by-step guide. Thousand Oaks, CA: Sage Publications, 1996

  2. McColl E, Jacoby A, Thomas L, et al. Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients. Health Technol Assess 2001; 5:1-256

  3. Boynton PM, Greenhalgh T. Selecting, designing and developing your questionnaire. BMJ 2004; 328:312-1315

  4. Mann KV. Not another survey! Using questionnaires effectively in needs assessment. J Cont Educ in the Health Prof 2005; 18:142-149
Related Terms:
Evidence-Based Clinical Practice Guidelines
Resources

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.