BALTIMORE--"Clinical practice guidelines link science and
the bedside, helping the doctor and patient to make the best possible
decisions," said Mary L. Grady, a technical writer-editor
with the Agency for Health Care Policy and Research (AHCPR).
Speaking at a panel at the American Medical Writers meeting, along
with other staffers from AHCPR's Center for Health Information
Dissemination, Ms. Grady said that her office has produced 17
clinical practice guidelines in the last 6 years and has another
"three or four" in development.
So far, only one--"Management of Cancer Pain"--concerns
oncology. Others are under consideration, but Congressional budget
battles make future plans uncertain, she said. "We are open
to nominations for topics, but AHCPR chooses subjects that affect
many people and for which there are variations in treatment,"
she said. "Also, since $6 million of the agency's budget
comes from Medicare, we look carefully at any topic that affects
the Medicare population."
The development process takes 18 to 24 months. Once a topic is
selected, a multidisciplinary panel is picked, an analytic framework
developed, and literature reviewed.
"We try to put together a review panel of people who may
have different views on treatment--like neurosurgeons and chiropractors,"
said Christine Williams, acting director of the Center. The review
panel rates the strength of the evidence, thrashes out a final
analysis, and offers its recommendations.
The approach, Ms. Grady said, "is explicitly scientific,
based on a comprehensive literature search, and open to revision
during the process. We also try to identify gaps in the knowledge
for future research."
Added editor Randie Siegel, "We try to present consistent
health messages. Every concept must be scientifically efensible."