Recent changes in the AAOS evidence-based clinical practice guidelines process.

Abstract

Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options1. In recent months, members of the American Academy of Orthopaedic Surgeons (AAOS) Committee on Evidence-Based Quality and Value (EBQV) have incorporated important changes to the processes and language of the AAOS Clinical Practice Guidelines (CPGs). The goal was to increase the clinical value to our members while maintaining high standards. EBQV committee members considered input from individual AAOS members, the specialty societies, and peer reviewers and also scanned the CPG development processes from other organizations prior to taking steps to improve the AAOS program. The AAOS quality program includes a rigorous, evidence-based-guideline-development process that meets all standards for developing trustworthy clinical practice guidelines as recommended by the 2011 Institute of Medicine (IOM) report entitled “Clinical Practice Guidelines We Can Trust.”1 These standards include establishing transparency, managing conflicts of interest, involving multidisciplinary experts and relevant stakeholders, assessing risk of study bias during systematic review construction, establishing evidence foundations for and rating the strength of recommendations, articulating recommendations in a standardized form that details the recommended action, having an external review process, and monitoring the literature and updating when appropriate. To enhance the clinical usefulness and clarity of the guideline recommendations, the EBQV committee adopted the changes listed below. The following list summarizes changes to the AAOS CPG methodology. ### Clarify Roles for Experts with Potential Financial Conflicts As mentioned previously, the AAOS CPG procedure meets all IOM standards for developing a trustworthy guideline, including managing …