ECRI to continue maintaining clearinghouses

ECRI Institute has received a five-year contract to continue operating and maintaining the National Guideline Clearinghouse and National Quality Measures Clearinghouse. Its duties under the contract with HHS' Agency for Healthcare Research and Quality will include implementing more rigorous inclusion criteria for evidence-based clinical practice guidelines.

Plymouth Meeting, Pa.-based ECRI—which does comparative effectiveness research on medical procedures, drugs, devices and processes—has been the sole contractor for the AHRQ's National Guideline Clearinghouse since 1997 and for the agency's National Quality Measures Clearinghouse since 2001. The clearinghouses provide summaries of evidence-based clinical practice guidelines and healthcare quality measures and measure sets. ECRI operates and maintains both websites, which the company estimates receive more than 3.4 million visits each year. The databases are publicly available and searchable.

The clearinghouses are intended to give physicians, clinicians, providers and policymakers objective, detailed information on clinical practice guidelines and measures. According to Mary Nix, project officer for AHRQ's NGC and NQMC about 80% of the guidelines used in the NGC come from medical specialty societies, while the remaining 20% are split among various groups that include the government, academic medical centers, research organizations and disease-specific groups such as the National Kidney Foundation.

Much of the focus of this new, multimillion contract to ECRI will be to implement more rigorous inclusion criteria and also to respond to the Institute of Medicine's 2011 recommendations on developing trustworthy guidelines.

“It's a big deal,” Nix said. “We haven't changed the criteria for guidelines since its inception.” The guidelines became publicly accessible on the website in 1998.

Up to now, the clearinghouse has used a 1990 definition of a clinical practice guideline. It now will act on the IOM's revised definition, which states that clinical guidelines should be based on a systematic review of evidence. The IOM also recommended other elements for guidelines to be considered “trustworthy,” which include being developed by a knowledgeable, multidisciplinary panel of experts and being reconsidered and revised as appropriate when new evidence merits changes of recommendations. Nix said she expects the number of guidelines will be reduced as AHRQ and ECRI work to implement more rigorous inclusion criteria.

“We're going to tackle the guidelines first, but we do have a statement for ECRI to look at the evidence underpinning measures of quality,” Nix said. “We see there is a need to tighten there also.”

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