Evaluating the use of the appropriateness method in the Agency for Health Care Policy and Research Clinical Practice Guideline Development process.
OBJECTIVE
To assess the feasibility of the appropriateness method in the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline Development process, and to compare the results of the appropriateness method with those obtained using evidence tables and an informal consensus method.


METHODS
AHCPR Low Back Problems Clinical Practice Guideline.


METHODS
Two different group process methods with the same panel of experts were used in observational comparison of results of and satisfaction with guideline development.


METHODS
Practice guideline statements were created for topics using the conventional AHCPR method; then six months later new guideline statements for four topics were created using the appropriateness method. Panelist satisfaction with each process and resulting set of guideline statements was assessed.


RESULTS
Results of the appropriateness method for TENS, discography, and traction showed no disagreement among panel members and no appropriate indications for their use in the patient scenarios considered. These results are qualitatively similar to the guideline statements produced using evidence tables and informal consensus. Clinical practice guideline statements about electro-diagnostics created from appropriateness ratings were much more clinically specific than those created using evidence tables and informal consensus. Neither informal consensus building nor the appropriateness method was clearly preferred by a majority of panelists.


CONCLUSIONS
It is feasible to use the appropriateness method in the AHCPR Clinical Practice Guideline Development process, and in some instances it produces more clinically specific guideline statements than does informal consensus.
Shekelle
P G
PG
West Los Angeles Veterans Affairs Medical Center, CA, USA.
Schriger
D L
DL
D000208:Acute Disease; D004568:Electrodiagnosis / Q000592:standards; D006126:Group Processes; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D016730:Program Development / Q000379:methods* / Q000706:statistics & numerical data; D015397:Program Evaluation / Q000379:methods* / Q000706:statistics & numerical data; D011859:Radiography; D012680:Sensitivity and Specificity; D014143:Traction / Q000592:standards; D004561:Transcutaneous Electric Nerve Stimulation / Q000592:standards; D014481:United States; D016270:United States Agency for Healthcare Research and Quality / Q000458:organization & administration*