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

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

• First Practice Bulletin

published in 1998

• 200 titles published

since inception

• Current Practice

Bulletins

• 45 Obstetric
• 35 Gynecology

• Methodology summary listed on published

document

• Posted on ACOG website
• Process undergoing update, so new process will

be published and posted on website

• Authors and Chairs required to have no related

financial conflicts

• Members with potential conflicts have restrictions
• n input and voting
• Conflicts for members and authors updated,

evaluated and disclosed to committee throughout process

• No external funding supports guideline

development work

• 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
• rganizatons
• Other Medical Specialty

Societies

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

• Based on previous

USPSTF methodology

• Evidence identified

based on inclusion/ exclusion criteria

• Recommendations

directly linked to evidence

• Evidence maps to review supporting evidence

quality and confirm recommendation

• Recommendations:
• Level A – good, consistent
• Level B – limited or inconsistent
• Level C – expert opinion

• Clinical Document

Review Panel

• Content review
• Ob Panel and Gyn

Panel

• 8 members each
• Previous Practice

committee membership

• Written response to

comments

• Executive Board
• Review by full

Executive Board

• Board leadership,

representatives from 12 ACOG Districts; partner organizations

• Primarily policy

review

• 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)

• 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

• 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

• 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

• 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)