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IOM offers standards for clinical practice, comparative effectiveness


By Jessica Zigmond
Posted: March 23, 2011 - 12:15 pm ET
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The Institute of Medicine has issued eight recommended standards to develop trustworthy clinical practice guidelines and 21 recommended standards for systematic review of the comparative effectiveness of medical or surgical interventions. The IOM also said it encourages HHS' Agency for Healthcare Research and Quality to pilot-test the standards and assess their reliability and validity. “If guideline users had a mechanism to immediately identify high quality, trustworthy clinical practice guidelines, their health-related decisionmaking would be improved—potentially improving both healthcare quality and health outcomes,” the IOM wrote in a description of its report Clinical Practice Guidelines We Can Trust, which outlines eight standards that address issues including transparency, conflict of interest and external reviews.

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Meanwhile, the second report—Finding What Works in Health Care: Standards for Systematic Reviews—focuses on the reviews that healthcare decisionmakers use for evidence-based comparisons of health interventions. In its description of the study, the IOM said systematic reviews identify, select, assess and synthesize the findings of similar but separate studies. “But the quality of systematic reviews varies; often the scientific rigor of the collected literature is not scrutinized or there are errors in data extraction and meta-analysis," the IOM wrote.

Included in the 21 guidelines are recommendations to first establish a team with appropriate expertise and experience to conduct the review; manage bias and conflict of interest; ensure user and stakeholder input as the review is designed and conducted; use a third party to manage the peer-review process; and publish the final report in a way that ensures free public access.

“This report presents the ‘gold standard' to which those who conduct systematic reviews should aspire to achieve the most reliable and useful products,” Dr. Alfred Berg, professor of family medicine at the University of Washington School of Medicine in Seattle, and chair of the committee that wrote the report, said in a news release. “We recognize that it will take an investment of resources and time to achieve such high standards, but they should be adopted to minimize the chances that important health decisions are based on information that may be biased or erroneous.”

Congress requested both studies through the Medicare Improvements for Patients and Providers Act of 2008, according to the IOM.


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