Room for Improvement in National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines

Abstract

Practice guidelines are everywhere in healthcare. They have been around for decades, but their development, dissemination, and—possibly—their use skyrocketed in the 1990s. At that time, guidelines were positioned at the crossroads of 2 developments. One was the arrival of an era of assessment and accountability in healthcare. Undesirable variation in practice, spiraling healthcare costs, and concerns about the overuse and underuse of services encouraged professionals to take action. The other was the increasing belief that clinical-practice and healthcare policy decisions should be guided by the best available evidence, a goal increasingly more difficult to achieve at the level of the individual, given the daunting number of medical journals and the avalanche of studies reported in them. Evidence-based practice guidelines were seen as helpful in tackling these challenges, and professional societies, government panels, and other groups increasingly began developing recommendations to assist healthcare professionals in delivering appropriate healthcare. Soon, guidelines were ubiquitous in practice and policy, and their rapid production and promulgation created a new problem: information overload. Not only was the sheer number of guidelines problematic, but guideline documents also varied considerably in form and appearance—from brief lists of dos and don'ts to lengthy documents of textbook-level completeness that summarized the state of the art in the field. This variability was a reason for concern, because the promotion of flawed guidelines could encourage or even institutionalize the delivery of ineffective, harmful, or wasteful interventions (1). In a typical “early days” process of guideline development, a group of invited experts would gather around a conference table to develop recommendations based on their understanding of the scientific evidence, their knowledge of the field, and their opinion. A formal methodology for evaluating the evidence was not always followed, and similarly absent were procedures for the consensus process. Given the vulnerability of the …