PUBLICATIONS
- RESEARCH DESIGN AND 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.
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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:
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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.
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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, credentialling 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.
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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.
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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 (http://medlineplus.gov/), 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 for this site is free of charge (http://www.medscape.com/)
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 PubMeb
From the PubMed homepage (http://www.ncbi.nlm.nih.gov/PubMed/)
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 (http://www.medicinedirect.com/journal/journal?sdid=5195)
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/
PubMed: http://www.ncbi.nlm.nih.gov/PubMed/
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