Health and Science Policy and Evidence-Based Medicine

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.

Suggested Reading

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.

Suggested Reading

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.

Suggested Reading (Systematic Reviews)

Suggested Reading (Survey Techniques)

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