The Development Of Reporting Standard For Health Care Practice Guideline

Backgrounds Following scientific and rigorous process, a practice guideline with appropriate reporting can promote the quality of healthcare, reduce healthcare cost, and improve patients’ health. Thousands of practice guidelines have been published in recent twenty years all over the world, the reporting quality of them varied a lot, especially for the methodology and recommendation, where important problems always occurred. Although reporting criteria for guidelines have been explored by a few organizations and institutions, all of them have limitations at different levels. It is necessary to establish a specific panel to develop international reporting criteria for practice guideline, which is applicable for clinical practice guidelines, public health and health policy guidelines.Objectives 1) To conduct a systematic review of the available handbooks of guideline development; 2) To assess the reporting quality of WHO guidelines published from 2008 to 2013; 3) To develop reporting criteria for practice guidelines in the area of health care; and 4) To assess the reporting quality of guidelines of the Integrative Medicine using the reporting criteria we developed.Methods Three methods were mainly adopted, including 1) bibliometrics analysis of the handbooks and guidelines,2) systematic review of the reporting quality of the handbooks and guidelines, and 3) Delphi consensus of the reporting items for practice guidelines.Results 1) Thirty four handbooks of guidelines development were included, of which ①91%(31) reported the composition of guideline groups with various names and scales;②59%(20) indicated the values and preferences should be included in guideline development, only 15%(5) provided detailed description;③82%(28) declared that the cost and economic of intervention should be considered, only 18%(6) gave detailed description; ④65%(22) reported the method used to achieve consensus, only 29%(10) described the details; ⑤71%(24) indicated the conflict of interest should be managed, only 59%(20) presented the detailed methods and steps; and ⑥ 67%(23) detailed the format for reporting or writing the guideline, they used different formats or items.2) One hundred and thirty three WHO guidelines were included, among which 33 different terms referred as guideline were used. And ①3%(4) reported the type of guidelines; ②65%(86) gave the executive summary;③59%(78) indicated they would be updated, but were all silent about the specific method and steps;④40%(54) described the applicable countries and regions;⑤55%(73) reported the rating system, in which 52%(69) used GRADE;⑥hen developing the recommendations,32%(43) and 47%(63) of the guidelines considered the values and preferences of patient and the cost and resource use respectively; and ⑦38%(51) reported the consensus method.3) We recruited 17 experts from 12 countries and international organizations using Delphi method.46 initial items were generated and after three rounds of Delphi survey,37 sub-items arranged under 21 key items were finally included.4) 41 Integrative Medicine guidelines published on 19 journals were included, of which ① 51%(21) described the number and names of guideline groups; ②15%(6) declared they have rated the evidence;③7%(3) presented the strengths of recommendations along with the quality of supporting evidence;④5%(2) reported the Delphi consensus when developing recommendations;⑤12%(5) reported their financial support without any description of the specific use of the funding and role of the sponsor;⑥all of the guidelines had no statement about whether they were based on systematic review, and only one gave the method for evidence retrieval.Conclusions 1) We found that the majority of the handbooks had the main aspects covered, but the methods for development were mostly based on expert opinions. The description of the important methods for guideline development was incomplete, details of the development process was unclear, and the chapter and items for how to report guidelines was lack. We suggest develop standards for assessing the quality of methodology and reporting of the handbooks of guideline to improve the scientific of the development and completeness of the reporting.2) Findings from the analysis of the reporting quality of WHO guidelines showed that most of the guidelines reported the methods and recommendations with various formats, and for the contents, insufficient information was found in respect of retrieval, assessment and grade of the evidence, values and preferences of patient, and the economic. GRC should add the chapter about how to regulate the reporting of the guidelines in WHO handbook for guideline development promptly, and enhance the standardization for the reporting during the review process of both rounds.3) The reporting criteria for healthcare practice guidelines we developed in this study covered the main information needed in guidelines, and put emphasis on the structured questions and systematic evidence retrieval, standardized consensus of recommendations, transparency of the management of conflict of interest, and the importance of the independent review. According to the reporting criteria, developers of different guidelines, such as clinical practice, public health or health policy guidelines, could report their guidelines comprehensively, clearly and explicitly.4) Using RIGHT items, we found the overall reporting quality of the Integrative Medicine guidelines was poor, especially for the unclear development process and recommendations. Because most of the experts in Integrative Medicine have limited knowledge about the Evidence-based Medicine and the methodology of guideline development, and some of the items from RIGHT are not completely suitable for Integrative Medicine guidelines, it is important and necessary to develop the reporting standard for Integrative Medicine guidelines based on RIGHT.