Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated?
BACKGROUND
Practice guidelines need to be up-to-date to be useful to clinicians. No published methods are available for assessing whether existing practice guidelines are still valid, nor does any empirical information exist regarding how often such assessments need to be made.


OBJECTIVE
To assess the current validity of 17 clinical practice guidelines published by the US Agency for Healthcare Research and Quality (AHRQ) that are still in circulation, and to use this information to estimate how quickly guidelines become obsolete.


METHODS
We developed criteria for defining when a guideline needs updating, mailed surveys to members of the original AHRQ guideline panels (n = 170; response rate, 71%), and searched the literature for evidence through March 2000 (n = 6994 titles yielding 173 articles plus 159 new guidelines on the same topics).


METHODS
Identification of new evidence calling for a major, minor, or no update of the 17 guidelines; survival analysis of the rate at which guidelines became outdated.


RESULTS
For 7 guidelines, new evidence and expert judgment indicated that a major update is required; 6 were found to be in need of a minor update; 3 were judged as still valid; and for 1 guideline, we could reach no conclusion. Survival analysis indicated that about half the guidelines were outdated in 5.8 years (95% confidence interval [CI], 5.0-6.6 years). The point at which no more than 90% of the guidelines were still valid was 3.6 years (95% CI, 2.6-4.6 years).


CONCLUSIONS
More than three quarters of the AHRQ guidelines need updating. As a general rule, guidelines should be reassessed for validity every 3 years.
Shekelle
P G
PG
RAND, 1700 Main St, PO Box 2138, Santa Monica, CA 90401, USA. shekelle@rand.org
Ortiz
E
E
Rhodes
S
S
Morton
S C
SC
Eccles
M P
MP
Grimshaw
J M
JM
Woolf
S H
SH
D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D014481:United States; D016270:United States Agency for Healthcare Research and Quality