Transparent Development of the WHO Rapid Advice Guidelines

Keio University, Edo, Tōkyō, Japan
PLoS Medicine (Impact Factor: 14.43). 06/2007; 4(5):e119. DOI: 10.1371/journal.pmed.0040119
Source: PubMed


Emerging health problems require rapid advice. We describe the development and pilot testing of a systematic, transparent approach used by the World Health Organization (WHO) to develop rapid advice guidelines in response to requests from member states confronted with uncertainty about the pharmacological management of avian influenza A (H5N1) virus infection. We first searched for systematic reviews of randomized trials of treatment and prevention of seasonal influenza and for non-trial evidence on H5N1 infection, including case reports and animal and in vitro studies. A panel of clinical experts, clinicians with experience in treating patients with H5N1, influenza researchers, and methodologists was convened for a two-day meeting. Panel members reviewed the evidence prior to the meeting and agreed on the process. It took one month to put together a team to prepare the evidence profiles (i.e., summaries of the evidence on important clinical and policy questions), and it took the team only five weeks to prepare and revise the evidence profiles and to prepare draft guidelines prior to the panel meeting. A draft manuscript for publication was prepared within 10 days following the panel meeting. Strengths of the process include its transparency and the short amount of time used to prepare these WHO guidelines. The process could be improved by shortening the time required to commission evidence profiles. Further development is needed to facilitate stakeholder involvement, and evaluate and ensure the guideline's usefulness.

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    • "The Decision Table, another table developed by GRADEpro, includes the rationale for making recommendations based on the underlying quality of evidence, the balance between benefits and harms, values and preferences, and resource considerations. This table is used to lay out judgments that guideline developers make when they develop recommendations [36]. "
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    ABSTRACT: Background Healthcare decision makers face challenges when using guidelines, including understanding the quality of the evidence or the values and preferences upon which recommendations are made, which are often not clear. Methods GRADE is a systematic approach towards assessing the quality of evidence and the strength of recommendations in healthcare. GRADE also gives advice on how to go from evidence to decisions. It has been developed to address the weaknesses of other grading systems and is now widely used internationally. The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE) consortium (, which includes members of the GRADE Working Group and other partners, will explore methods to ensure effective communication of evidence-based recommendations targeted at key stakeholders: healthcare professionals, policymakers, and managers, as well as patients and the general public. Surveys and interviews with guideline producers and other stakeholders will explore how presentation of the evidence could be improved to better meet their information needs. We will collect further stakeholder input from advisory groups, via consultations and user testing; this will be done across a wide range of healthcare systems in Europe, North America, and other countries. Targeted communication strategies will be developed, evaluated in randomized trials, refined, and assessed during the development of real guidelines. Discussion Results of the DECIDE project will improve the communication of evidence-based healthcare recommendations. Building on the work of the GRADE Working Group, DECIDE will develop and evaluate methods that address communication needs of guideline users. The project will produce strategies for communicating recommendations that have been rigorously evaluated in diverse settings, and it will support the transfer of research into practice in healthcare systems globally.
    Full-text · Article · Jan 2013 · Implementation Science
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    • "The clinical content of an evidence-based care pathway for COPD exacerbation was developed based on the process design methodology developed by Berry et al.[16], and the guideline development methods of the American College of Chest Physicians (ACCP) [17], the World Health Organization (WHO) [18] and the Healthcare Infection Control Practices Advisory Committee (HICPAC) [19]. Subsequently, based on the experiences of the COPD case, a generalized eight-step method for development of the clinical content of an evidence based care pathway was designed (Figure 1). "
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    ABSTRACT: BackgroundOptimization of the clinical care process by integration of evidence-based knowledge is one of the active components in care pathways. When studying the impact of a care pathway by using a cluster-randomized design, standardization of the care pathway intervention is crucial. This methodology paper describes the development of the clinical content of an evidence-based care pathway for in-hospital management of chronic obstructive pulmonary disease (COPD) exacerbation in the context of a cluster-randomized controlled trial (cRCT) on care pathway effectiveness.MethodsThe clinical content of a care pathway for COPD exacerbation was developed based on recognized process design and guideline development methods. Subsequently, based on the COPD case study, a generalized eight-step method was designed to support the development of the clinical content of an evidence-based care pathway.ResultsA set of 38 evidence-based key interventions and a set of 24 process and 15 outcome indicators were developed in eight different steps. Nine Belgian multidisciplinary teams piloted both the set of key interventions and indicators. The key intervention set was judged by the teams as being valid and clinically applicable. In addition, the pilot study showed that the indicators were feasible for the involved clinicians and patients.ConclusionsThe set of 38 key interventions and the set of process and outcome indicators were found to be appropriate for the development and standardization of the clinical content of the COPD care pathway in the context of a cRCT on pathway effectiveness. The developed eight-step method may facilitate multidisciplinary teams caring for other patient populations in designing the clinical content of their future care pathways.
    Full-text · Article · Nov 2012 · Trials
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    • "Approaches to doing this have been described in a recent policy of the American Thoracic Society [29]; an example is in a WHO guideline on Avian Influenza where un-conflicted methodologists prepared evidence summaries, chaired the guideline committee and wrote the first draft of the guideline. [45,46] A further implementation including a clearer separation of un-conflicted methodologists from the influence of potentially conflicted experts is currently undertaken by the executive committee of the American College of Chest Physicians Antithrombotic Guidelines. [47] In this latter approach un-conflicted methodologists lead the formulation of recommendations in collaboration with experts who may be conflicted to a degree that would not preclude them from participation. "
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    ABSTRACT: Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.
    Full-text · Article · Jul 2012 · Implementation Science
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