According to a National Heart, Lung, and Blood Institute (NHLBI) report jointly published June 19 in the Journal of the American College of Cardiology and Circulation, the NHLBI is refocusing its clinical practice guideline development process, and is adopting a new collaborative, partnership model.
The report details the history of NHLBI's clinical guideline development, which includes cholesterol, blood pressure, asthma, von Willebrand Disease, and more. However, the authors note that "in the ensuing years, the landscapes surrounding the management of blood pressure and cholesterol disorders, as well as the landscape of clinical practice guidelines, have undergone profound changes."
In response to these changes, the authors note, "We plan to refocus our health education agenda on our core mission of knowledge generation and synthesis by supporting and producing rigorous systematic reviews that can then be used by other collaborating organizations to generate guideline products that serve the public interest. The NHLBI has decided that the five integrated cardiovascular guideline products will be published as evidentiary reviews, and that the Institute will subsequently collaborate with other organizations to prepare and issue the related clinical practice guidelines." They add that "When multiple stakeholders work together collaboratively, there is a much greater likelihood of high-quality products, products that reflect diverse perspectives, philosophies, and expertise."
The specific elements of the new model are still under development, but the principles include:
- "Before taking on new evidence syntheses, the NHLBI will consult closely with external stakeholders to identify high-priority needs with compelling relevance to the NHLBI mission and the health of the nation.
- Once those needs are identified, the NHLBI will work with external stakeholders to determine which critical questions are most crucial for their ability to generate guidelines that are reliable, robust, credible, relatively easy to implement and likely to promote significant improvements in public health.
- In supporting and generating evidence syntheses, the NHLBI will pay careful attention to the evolving standards on systematic reviews promulgated by the Institute of Medicine and other credible sources.
- In enabling partner organizations to generate their own guideline products, the NHLBI will continue to abide by the highest standards for developing trustworthy clinical practice guidelines and continue to adapt as best practices and the landscape of stakeholders evolve.
- The NHLBI will implement a process for internal evaluation and continuous improvement in line with our commitment to results-based accountability and stewardship of public resources.
- The syntheses will identify evidence gaps which can guide research investments in areas of importance to public health."
"As we adapt to changing times and refine the focus of our health education efforts, we remain steadfastly committed to fulfilling our mission by facilitating the generation of rigorous systematic evidentiary reviews in support of the highest quality clinical practice guidelines worthy of the public trust," the authors add.
"The ACC has been a leader of the development and publication of clinical practice guidelines since the early 1980s along with the American Heart Association," said John Gordon Harold, MD, MACC, president of the ACC. "We are open to collaborating with other stakeholders as the development of guidelines is at the core of our mission and supports patient-centered care."