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They also need to be checked again for one year after the baby is born. EVIDENCE-BASED CLINICAL GUIDELINES A. WHAT IS THE EVIDENCE-BASED PROCESS? As a result of the Medicare Improvements for Patients and Providers Act of 2008, Congress commissioned the Secretary of Health and Human Services to create a public-private program to develop and promote a common set of standards for the development of clinical practice guidelines (CPGs). These standards address the structure, process, reporting, and final products of systematic reviews of scientific research and evidence-based clinical practice guidelines. The Institute of Medicine (IOM), now the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine (NASEM), in response to a request from the Agency for Healthcare Research and Quality (AHRQ), issued two reports in March 2011: Clinical Practice Guidelines We Can Trust and Finding What Works in Health Care: Standards for Systematic Reviews. In Clinical Practice Guidelines We Can Trust,1 the IOM redefined CPGs as follows: “Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care options.” The report states that to be trustworthy, guidelines should: • Be based on a systematic review of existing evidence • Be developed by a knowledgeable, multidisciplinary panel of experts and key stakeholders • Consider important patient subgroups and preferences, as appropriate • Be based on a transparent process that minimizes conflicts of interest and biases • Provide a clear explanation of the logical relationships between alternative care options and health outcomes • Provide a grading of both the quality of evidence and the strength of the clinical recommendation • Be revised as appropriate when new evidence warrants modifications of recommendations. Based on the IOM/NASEM reports, the American Optometric Association (AOA) Evidence-Based Optometry (EBO) Committee developed a 14-step process to meet the new evidence-based recommendations for trustworthy guidelines. 7 aoa.org AOA’s 14 Steps to Evidence-Based Clinical Practice Guideline Development 1.
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