Article type
Year
Abstract
Background: Clinical practice guidelines (CPGs) and systematic reviews (SRs) provide evidence on which many informed healthcare decisions are made. However, CPGs and SRs may become out-of-date at variable rates. It is therefore essential to keep CPGs and SRs up-to-date. The first step in using the organization’s resources efficiently is to determine which CPGs or SRs are in need for updating. Thereafter, aligning with the organization’s updating capacity, out-of-date CPGs and SR are prioritized to determine which updates are needed the most.
Objectives: To provide a structured overview of indicators to determine whether a CPG or SR is out-of-date and needs updating.
Methods: We searched MEDLINE and PubMed Health for relevant journal articles. Additional studies, reports, and handbooks were identified through searching websites of healthcare organizations and checking references. We included studies, reports, and handbooks when they reported indicators whether CPGs or SRs were out-of-date. We performed qualitative analyses (open and axial coding) in NVivo 12 for Windows on the extracted indicators to find common topics among the indicators.
Results: We identified 25 studies, 7 reports, and 19 handbooks, from which we preliminary identified 185 indicators that were used to identify out-of-date CPGs or SRs. Sixteen topics emerged: access of care and (in)equality (n=4), changes in PICO elements (n=15), (un)certainty / strength / direction of findings (n=4), feedback and requests (n=14), implementation (n=6), new developments (n=2), methods (n=4), need for new questions (n=2), new evidence (n=97), organizational considerations (n=5), previous guidance (n=2), relevance (n=5), resources (n=5), time (n=2), variation or suboptimal practice (n=4), and other (n=14). Preliminarily, we also found nine indicators for when not to update CPGs or SRs: maintained validity (n=5), postpone (n=2), and other (n=2). Furthermore, we preliminary extracted 21 indicators that determined whether a CPG or SR could be retracted. Here, the following topics emerged: low priority (n=2), new developments (n=10), outside a scope (n=2), superseded or outdated (n=5), and other (n=2).
Conclusions: We found a large number of indicators that concern the addition of new evidence. Although new evidence might be an important indicator for an update, the number of new studies itself is probably not a signal of outdatedness. The certainty or direction of CPG recommendations probably changes when more information is added through larger study samples and more observed events. Indicators concerning the power, strength, direction or the addition of (new) recommendations or conclusions are therefore probably informative to assess the need for updating. Depending on the organization’s policy, additional indicators may be used. These might include indicators about the variation of practice, feedback from users, and resource use.
Patient or healthcare consumer involvement:
Up-to-date CPGs are important for patients to receive the best medical care available.
Objectives: To provide a structured overview of indicators to determine whether a CPG or SR is out-of-date and needs updating.
Methods: We searched MEDLINE and PubMed Health for relevant journal articles. Additional studies, reports, and handbooks were identified through searching websites of healthcare organizations and checking references. We included studies, reports, and handbooks when they reported indicators whether CPGs or SRs were out-of-date. We performed qualitative analyses (open and axial coding) in NVivo 12 for Windows on the extracted indicators to find common topics among the indicators.
Results: We identified 25 studies, 7 reports, and 19 handbooks, from which we preliminary identified 185 indicators that were used to identify out-of-date CPGs or SRs. Sixteen topics emerged: access of care and (in)equality (n=4), changes in PICO elements (n=15), (un)certainty / strength / direction of findings (n=4), feedback and requests (n=14), implementation (n=6), new developments (n=2), methods (n=4), need for new questions (n=2), new evidence (n=97), organizational considerations (n=5), previous guidance (n=2), relevance (n=5), resources (n=5), time (n=2), variation or suboptimal practice (n=4), and other (n=14). Preliminarily, we also found nine indicators for when not to update CPGs or SRs: maintained validity (n=5), postpone (n=2), and other (n=2). Furthermore, we preliminary extracted 21 indicators that determined whether a CPG or SR could be retracted. Here, the following topics emerged: low priority (n=2), new developments (n=10), outside a scope (n=2), superseded or outdated (n=5), and other (n=2).
Conclusions: We found a large number of indicators that concern the addition of new evidence. Although new evidence might be an important indicator for an update, the number of new studies itself is probably not a signal of outdatedness. The certainty or direction of CPG recommendations probably changes when more information is added through larger study samples and more observed events. Indicators concerning the power, strength, direction or the addition of (new) recommendations or conclusions are therefore probably informative to assess the need for updating. Depending on the organization’s policy, additional indicators may be used. These might include indicators about the variation of practice, feedback from users, and resource use.
Patient or healthcare consumer involvement:
Up-to-date CPGs are important for patients to receive the best medical care available.