systematic reviews evidence to advance decision making

Systematic Reviews: Evidence to Advance Decision Making Nancy - PowerPoint PPT Presentation

Systematic Reviews: Evidence to Advance Decision Making Nancy OReilly, MHS, PMP Senior Director, Gynecologic Practice and WPSI American College of Obstetricians and Gynecologists November 1, 2018 First Practice Bulletin published in

  1. Systematic Reviews: Evidence to Advance Decision Making Nancy O’Reilly, MHS, PMP Senior Director, Gynecologic Practice and WPSI American College of Obstetricians and Gynecologists November 1, 2018

  2. • First Practice Bulletin published in 1998 • 200 titles published since inception • Current Practice Bulletins ◦ 45 Obstetric ◦ 35 Gynecology

  3. • Methodology summary listed on published document • Posted on ACOG website • Process undergoing update, so new process will be published and posted on website

  4. • Authors and Chairs required to have no related financial conflicts • Members with potential conflicts have restrictions on input and voting • Conflicts for members and authors updated, evaluated and disclosed to committee throughout process • No external funding supports guideline development work

  5. • Standing committees 1) Gynecology and 2) Obstetrics • 8-10 Ob-Gyn members with methodologic expertise • 2 public members • Collaboration in document development ◦ Ob-Gyn subspeciality organizatons ◦ Other Medical Specialty Societies

  6. • Evidence Review ◦ In-house medical librarians ◦ MEDLINE database, Cochrane Library, Guidelines from other organizations or institutions ◦ Based on PICO elements identified in outline • Organized by level of evidence : o Systematic Reviews * o Randomized Controlled Trials o Observational Studies o Organizational Guidelines

  7. • Based on previous USPSTF methodology • Evidence identified based on inclusion/ exclusion criteria • Recommendations directly linked to evidence

  8. • Evidence maps to review supporting evidence quality and confirm recommendation • Recommendations: ◦ Level A – good, consistent ◦ Level B – limited or inconsistent ◦ Level C – expert opinion

  9. • Executive Board • Clinical Document Review Panel ◦ Review by full ◦ Content review Executive Board ◦ Ob Panel and Gyn ◦ Board leadership, Panel representatives from ◦ 8 members each 12 ACOG Districts; ◦ Previous Practice partner organizations committee membership ◦ Primarily policy ◦ Written response to review comments

  10. • Published in Obstetrics and Gynecology • Full guideline reviewed every 18-24 months at in-person meeting • Horizon scan for new evidence on-going for each topic • Updated when new clinical data would prompt change to recommendation(s)

  11. • Engaged with AHRQ EPCs since 1998 ◦ Nomination of topics ◦ Participation in Technical Expert Panels ◦ Expert review of final reports • Partner with several EPCs including: ◦ Duke ◦ UNC/RTI ◦ Vanderbilt ◦ OHSU • Review EPC reports as partner organization to USPSTF

  12. • Collaboration with EPCs allows identification and evaluation of most important clinical issues • Clinical experts/authors involved at each stage of S/R development • Input at PICO development stage • Prioritized as highest level of evidence to develop accurate recommendations • Serves as the anchor to our clinical practice guidelines

  13. • Over 20 Practice Bulletin titles based on EPC Systematic Reviews • Practice Bulletin #137 Gestational Diabetes Mellitus (2013) • Practice Bulletin # 131 –Screening for Cervical Cancer (2013) • Practice Bulletin #129 – Osteoporosis (2012) • Practice Bulletin #107 Induction of Labor (2009) • Practice Bulletin #105 – Bariatric Surgery and Pregnancy (2009) • Practice Bulletin #96 – Alternatives to Hysterectomy in Management of Leiomyomas (2008) ► Additional topics in process

  14. • Committee Opinions • CO 561 -Nonmedically Indicated Early-Term Deliveries (2013) • CO 559 - Cesarean Delivery on Maternal Request (2013) • CO 372 - The Role of Cystourethroscopy in the Generalist Obstetrician-Gynecologist Practice (2007) • Books and special projects • Hypertension in Pregnancy Task Force Report (2013) • Induction of Labor - Patient Safety Checklist (2011) • Neonatal Encephalopathy and Cerebral Palsy-Defining the Pathogenesis and Pathophysiology (2003)

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