Web site offers database of national guidelines

Searchable tool lets you compare similar topics

There’s a patient with a broken wrist in one room, a woman in false labor next door, a crying 3-year-old who’s too scared to urinate in a cup, and a dad who needs directions on using his son’s peak flow meter. It goes without saying that there’s another group of patients in the waiting room, a pharmacist on line two, and no time for lunch.

If that’s your day as a physician — and that’s a good day with no crises — then when do you find time to keep up with the latest scientific research? You try to read the journals, of course, but what about those reams of guidelines for different conditions that are spilling off your bookshelves, stacking up on your floor, maybe even ending up in the trash can? Many of them never get read. Even if they are seen once, they’re never referred to again because they’re too long, too complicated, and where the heck did you put that one, anyway?

There’s now a quick, easy, and surprisingly uncomplicated way to use national guidelines — provided by the government. The federal Agency for Healthcare Policy and Research (AHCPR) has help available in the form of the National Guideline Clearinghouse, a free Internet database of clinical practice guidelines. Developed by AHCPR in partnership with the American Medical Association (AMA)and the American Association of Health Plans (AAHP), the clearinghouse features evidence-based guidelines and presents them with standardized abstracts and tables that allow for comparison of guidelines on similar topics.

In the situation of the dad who needs peak flow meter directions: How often should his son be using the device? Go to www.guideline.gov, type in asthma, and you’ll get a list of 21 guidelines that you can read in summary form. The full text version is also available. Want to know how each one differs? Pick a few guidelines, click on guideline comparison, and you’ll see the major areas of agreement and disagreement among the guidelines. Not sure which one you should follow? Click on a topic-related e-mail discussion group and ask other users what their opinions are about the guidelines.

The AHCPR does not know yet whether physicians will use the clearinghouse for real-time decision making, but at least they’ll have the option. And they won’t have to rummage through stacks of papers to find a guideline.

"Millions have been spent already on guidelines, but we haven’t gotten the value back because when doctors need them, they don’t have access to them," says William F. Jessee, MD, the AMA’s vice president of quality and managed care standards.

If physicians don’t have access, they won’t change their practice patterns as the guidelines would suggest. "It is well known that variation in health care results partly from uncertainty and a lack of evidence for clinical treatment," says John Eisenberg, MD, AHCPR administrator. "The clearinghouse will help reduce variation and improve health care quality by giving clinicians and other health professionals a source of information on evidence-based treatment to help guide their decisions."

Currently, 286 guidelines developed by specialty societies, federal agencies, health plans, hospitals, and others are listed in the clearinghouse. Eisenberg says he expects that number to reach 3,500 within three years.

Besides the easy access, the other main benefit of this database is that the guidelines must meet certain criteria to be included. They must:

- be current;
- contain systematically developed statements to help guide practitioners’ or patients’ decisions;
- have been produced by a medical or other relevant professional group, government agency, health care organization or plan, or other public or private organization;
- document that they were developed through a systematic search of peer-reviewed scientific evidence.

"Previously, it’s been difficult to know which guidelines are evidence-based. In some quarters, that’s given guidelines a bad name," says Karen Ignagni, AAHP’s president and CEO. "The clearinghouse will be an important tool in clinical decision making as we continue to address the problems of underuse, overuse, misuse, uncertainty, and unevenness in health care quality."

Yank Coble, MD, an endocrinologist from Jacksonville, FL, who is an AMA trustee, says he agrees that the clearinghouse will have more credibility with physicians. He says he’ll be one of the first physicians to throw out his stacks of paper guidelines. "There’s a great deal of pollution regarding guidelines," Coble says. "Doctors are so aware that there are bad guidelines out there, they’ll be relieved to have a credible source. These guidelines contain evidence-based scientific knowledge that is a vital component of quality medical care."

Eisenberg says the clearinghouse should help identify clinical topics for which guidelines don’t exist. "The clearinghouse will help the practice of medicine catch up with the science of medicine," he says.

[For more information, contact AHCPR at 2101 E. Jefferson St., Rockville, MD 20852. Telephone: (301) 594-6662. AHCPR’s Web address: www.ahcpr.gov.]