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In this interview, John B. Forrest, MD, chair of the Practice Guidelines Committee, discusses how the committee has changed over the years, its process for creating guidelines, and future plans.
Q As chair of this very important committee, please tell us about the difference among best practices, guidelines, and other documents, and how the committee addresses each of these.
A full practice guideline is a heavily analyzed, evidence-based document with an explicit and focused clinical scope and purpose. It is strongly evidence-based, using randomized, controlled trials when available. Otherwise, non-randomized, controlled data is used if it is considered robust. It is a systematic scientific review with data extraction and meta-analysis.
A policy statement is a straightforward declaration on a particular topic, which includes a cursory review of the literature, including non-published studies and possibly industry studies. It is developed by a small group of experts chosen by committee chairs and/or staff. Its use may be dictated by government agencies or endorsement of other policies from other sources, such as other specialty societies.
A technology assessment is a state-of-the-art assessment of the clinical utility of medical interventions with a systematic review of literature. Panel members review the literature and determine data to be extracted.
A white paper is an article that states the AUA position or philosophy on a certain topic and is more comprehensive than a policy statement. Outside sources are utilized and a bibliography is included. The results or conclusions occurring from committee research collaboration are then also explained within the document.
With the evolution of these various documents, we have created a system that is much more transparent in reflecting the levels of evidence that are used to create a certain level of recommendation. This, we feel, is a marked move forward in our process and will make the guidelines much more valuable to the consumers of these products. It is also very important to remember that all of these documents undergo review, not only by the committee that constructs the original document, but by outside reviewers, the full Practice Guidelines Committee, and the AUA Board of Directors.
Q How long is the guidelines process?
A The previous guideline process-in place 10 to 15 years ago-lasted up to 36 months. Through the tremendous work of the AUA staff and the expansion of the practice guidelines department, we've been able to trim that down to a much shorter, 18- to 24-month timeframe. The length of time also depends on the type of statement that is required; ie, whether it's a best practice statement or a full guideline document.