Research Design & Stats
Locating Practice Guidelines
The citations within this section are provided as a starting point for life care planners interested in reviewing the clinical practice guidelines of several specialty practice areas. It is not possible to provide a comprehensive list of references, however, because each patient presents a unique set of circumstances and the practice guidelines that you consult as part of your plan development will depend upon the specific needs of the individual with whom you are working.
Beginning the Search
When seeking clinical practice guidelines specific to the patient with whom you are working, you may begin your search in the following ways:
Literature Review
In reviewing the research literature related to a patient’s case, it is likely that authors will have referenced clinical practice guidelines within their articles. This not only saves you time in locating the documents, but provides you with insight when evaluating the validity of the findings of studies which relied heavily upon the guidelines as a basis for their methodology.
The Internet
Many professionals find that the Internet is one of the most efficient ways to locate information if, of course, you are able to hit upon an effective search methodology. In addition to referencing the databanks provided within this chapter, you may search the websites of national organizations, state agencies, credentialing bodies, and similar associations. When utilizing practice guidelines provided on an organization’s website, it is a good idea to actually contact the organization to verify that they have posted the most current document. If not explicitly stated in the guidelines, you should ask for information regarding the development methodology.
The Treatment Team
Ask members of the treatment team or other professional contacts for information regarding the practice guidelines that exist within their specialty area or profession. These individuals will likely save you time in locating the guidelines and may be able to provide a specific citation.
State and National Organizations
Contact state and national organizations directly and request a copy of their clinical practice guidelines. In speaking with representatives, you will have an opportunity to learn more about the group and about the guideline development methodology.
Databases:
Agency for Healthcare Research and Quality
Agency for Healthcare Research and Quality (AHRQ) maintains an extensive website and may be helpful to life care planners seeking clinical practice guidelines. The following information was extracted directly from the Agency’s website:
The AHRQ is, “The health services research arm of the U.S. Department of Health and Human Services (HHS), complementing the biomedical research mission of its sister agency, the National Institutes of Health. It is home to research centers that specialize in major areas of health care research:
*Quality improvement and patient safety.
*Outcomes and effectiveness of care.
*Clinical practice and technology assessment.
*Health care organization and delivery systems.
*Primary care (including preventive services).
*Health care costs and sources of payment.
*A major source of funding and technical assistance for health services research and research training at leading U.S. universities and other institutions.
*A science partner, working with the public and private sectors to build the knowledge base for what works—and does not work—in health and health care and to translate this knowledge into everyday practice and policymaking.
In examining what works and does not work in health care, AHRQ’s mission includes both translating research findings into better patient care and providing policymakers and other health care leaders with information needed to make critical health care decisions.”
The National Guideline Clearinghouse
The National Guideline Clearinghouse (NGC) provides a comprehensive databank of evidence-based clinical practice guidelines and other relevant documents. The following information was extracted directly from the Clearinghouse’s website:
“The National Guideline Clearinghouse (NGC) is a comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Healthcare Research and Quality (AHRQ) (formerly the Agency for Health Care Policy and Research [AHCPR]), in partnership with the American Medical Association (AMA) and the American Association of Health Plans (AAHP).
The NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.
The National Guideline Clearinghouse will promote widespread access to clinical practice guidelines through a comprehensive database of clinical practice guidelines. Data on each guideline will include:
(1) a structured abstract containing information about the guideline and its development
(2) a comparison of guidelines covering similar topics, showing areas of similarity and difference; and
(3) the full-text of the guidelines (when available) or links to the full-text (when not) and ordering details for the full guideline.
In addition, the National Guideline Clearinghouse will provide an electronic forum for exchanging information on clinical practice guidelines, their development, implementation and use.”
Association and Agency Sites
Even though the AHRQ and NGC attempt to maintain comprehensive databases, not all organizations are currently included in these sources. The following citations are provided so that you may add them to you research databank:
American Academy of Neurology:
http://www.aan.com/professionals/practice/guidelines.cfm
American Academy of Pediatrics:
http://www.aap.org/policy/paramtoc.html
American College of Cardiology:
http://www.acc.org/clinical/topic/topic.htm#guidelines
National Heart, Lung, and Blood Institute:
(Hypertension) http://www.nhlbi.nih.gov/guidelines/hypertension/index.htm
Note: Although the paths may change as webmasters improve these websites, it is likely that the clinical practice guidelines will remain posted. Most all of these guidelines appear as links from the homepages of the associations. Alternately, perform a keyword search on the site for “practice guidelines” or “guidelines,” or view the site map for a link to the information.
Searching MedlinePlus
Locating clinical practice guidelines on MedlinePlus is simple. From the homepage, enter a search for “practice guidelines.”
You will be linked to a page with all topics and references related to your search. From this page, select areas of interest. The primary limitation with this method of searching is that you may only be directed to pages containing the phase you typed into the search, rather than to the actual practice guideline for which you are seeking.
Searching Medscape
Registration at MedScape is free of charge and contains a great deal of information useful to life care planners. Similar to Medline, by entering a search for “practice guidelines” from the homepage, you will be linked to all topics and references related to your search.
Note that directly underneath the “Search” box, you may link to Medline. In doing so, you will be led to a screen entitled, “Search Medline.” From here you can tailor your search to your specific needs. For example, when “practice guidelines” is typed into the “Search Query” box (with no other parameters defined), 200 references are returned. The limitation of this site, however, is that not all articles are available for full-text viewing but citations are provided so that you may locate the publication elsewhere.
Searching PubMed
From the PubMed homepage, you may search the site for “practice guidelines” to retrieve all of the references related to the topic. For example, when this phrase was entered as a search, 1,075 references were cited. As with Medscape, not all articles are available for full-text viewing but citations are provided so that you may locate the publication elsewhere.
Searching Online Journals
Another option for locating clinical practice guidelines is to go directly to an online journal and perform an internal search of the publication. In some cases, even journals that do not provide full-text articles online will allow users to search the abstracts.
For example, when the American Journal of Medicine is searched for the phrase, “practice guidelines” in all fields, 122 results are returned.
Once you have located the clinical practice guidelines of interest, be certain to review the development methodology and find out as much as you can in order to evaluate the validity and relevance of the guidelines to your patient.
Another example of the importance of networking, continually updating your reference and contact files, and establishing an efficient databank.
References
Agency for Healthcare Research and Quality: http://www.ahcpr.gov
American Journal of Medicine: http://www.amjmed.org
MedlinePlus: http://medlineplus.gov
Medscape: http://www.medscape.com
National Guideline Clearinghouse: http://www.guideline.gov