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ORIGINAL INVESTIGATION HEALTH CARE REFORM Failure of Clinical Practice Guidelines to Meet Institute of Medicine Standards Two More Decades of Little, If Any, Progress Justin Kung, MD; Ram R. Miller, MD; Philip A. Mackowiak, MD Background: In March 2011, the Institute of Medicine chairpersons. Except for US government agency– (IOM) issued a new set of standards for clinical practice produced guidelines, criteria used to select committee guidelines intended to enhance the quality of guidelines members and the selection process were rarely de- being produced. To our knowledge, no systematic re- scribed. Committees developing guidelines rarely in- view of adherence to such standards has been under- cluded an information scientist or a patient or patient rep- taken since one published over a decade ago. resentative. Non-English literature, unpublished data, and/or abstracts were rarely considered in developing Methods: Two reviewers independently screened 130 guidelines; differences of opinion among committee mem- guidelines selected at random from the National Guide- bers generally were not aired in guidelines; and benefits line Clearinghouse (NGC) website for compliance with of recommendations were enumerated more often than 18 of 25 IOM standards. potential harms. Guidelines published from 2006 through Results: The overall median number (percentage) of IOM
JAMA Internal Medicine – American Medical Association
Published: Nov 26, 2012
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