Timothy J. Wilt, MD: Behind the Updated ACP Guidelines

The ACP's guideline committee chair discusses the thought process that went into their own update on clinical standards of guidance.

The American College of Physicians (ACP) released a paper detailing their methods for creating both clinical guidelines and guidance statements.

Given the variety of specialties, conditions, and frequent advances made in the world of medicine, guidelines regularly evolve in response. The ACP strived to summarize the best available advice in their updated guidelines, prompting multiple significant changes.

Following the paper’s publication, Timothy J. Wilt, MD, MACP, chair of ACP’s Clinical Guidelines Committee, spoke to MD Magazine® about the updated guidelines and the reasoning behind the recent changes.

MD Mag: What is the most important change the ACP has made to their methodology of guidelines/guidance?

Wilt: There are several important changes in ACP guideline methodologies and processes that readers should be aware of. All are intended to improve the rigor, reliability, and usefulness of ACP guidelines and guidance statements. These include: more stringent policies about disclosure of interests and conflict management, inclusion of public perspective, full adoption of Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods, more standardized reporting formats that consider value of care, patient values, preferences and comorbid conditions and costs, enhancements to readability and usability, clarification of guidance statement methods.

Why should clinicians trust the ACP above others when there are so many organizations that release guidelines?

ACP guidelines are scientifically sound and clinically pragmatic. ACP guidelines are developed by a multidisciplinary panel of clinicians representing general and specialty internal medicine along with public members trained in evidence-based medicine who have expertise and perspectives across a broad range of health topics. ACP guidelines are derived from a rigorous review of the best scientific evidence that evaluates clinical benefits and harms and communicated in a fashion that provides actionable recommendations to aide physicians in providing high quality patient centered care.

What motivated the ACP to release this paper detailing their methodology?

ACP initiated its guideline development program in 1981 and is a recognized international leader in clinical guideline development. ACP continuously updates its methods and processes in order to enhance the quality, trustworthiness, and usability of our guidelines and guidance statements. Releasing this paper to a wide audience clarifies the methods used, increases end user confidence in the reliability of ACP-guideline statements, enhances implementation of ACP guideline and guidance statements, and encourages other guideline groups to adopt similar high-quality methodological standards.

What do you hope the release of this paper accomplishes?

We believe that the release of our updated methods/development processes (along with guidelines and guidance statements developed from these methods) will increase use by physicians, patients, and health care systems. We hope that it will serve as a foundation for future advancements in guideline development methods which can include the incorporation of cost of care into clinical recommendations as well as the adoption of similar state-of-the-art methodological standards by other clinical guideline groups.

Current and previous ACP’s guidelines can be found on their Clinical Guidelines app.

The paper, “The Development of Clinical Guidelines and Guidance Statements by the Clinical Guidelines Committee of the American College of Physicians: Update of Methods,” was published in Annals of Internal Medicine.