Improving the use of research evidence in guideline development: 16. Evaluation
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Improving the use of research evidence in guideline development: 16. Evaluation Andrew D Oxman*1, Holger J Schünemann2 and Atle Fretheim1 Address: 1Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N-0130 Oslo, Norway and 2INFORMA, S.C. Epidemiologia, Istitituto Regina Elena, Via Elio Chianesi 53, 00144 Rome, Italy Email: Andrew D Oxman* - [email protected]; Holger J Schünemann - [email protected]; Atle Fretheim - [email protected] * Corresponding author
Published: 08 December 2006 Health Research Policy and Systems 2006, 4:28
doi:10.1186/1478-4505-4-28
Received: 07 April 2006 Accepted: 08 December 2006
This article is available from: http://www.health-policy-systems.com/content/4/1/28 © 2006 Oxman et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the last of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. Objectives: We reviewed the literature on evaluating guidelines and recommendations, including their quality, whether they are likely to be up-to-date, and their implementation. We also considered the role of guideline developers in undertaking evaluations that are needed to inform recommendations. Methods: We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. Key questions and answers: Our answers to these questions were informed by a review of instruments for evaluating guidelines, several studies of the need for updating guidelines, discussions of the pros and cons of different research designs for evaluating the implementation of guidelines, and consideration of the use of uncertainties identified in systematic reviews to set research priorities. How should the quality of guidelines or recommendations be appraised? • WHO should put into place processes to ensure that both internal and external review of guidelines is undertaken routinely. • A checklist, such as the AGREE instrument, should be used. • The checklist should be adapted and tested to ensure that it is suitable to the broad range of recommendations that WHO produces, including public health and health policy recommendations, and that it includes questions about equity and other items that are particularly impo
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