IOM on Trustworthy Evidence-Based Medicine

The Institute of Medicine issued two reports designed to help ensure that research designed to help create guidelines for treatment, and the guidelines themselves, are of as high a quality as possible.  The first report is called Clinical Practice Guidelines We Can Trust.  This work is a tremendous resource not only for those who are preparing guidelines, but for those health professionals who are expected to or want to use them, and need to have a sense of how trustworthy they are.  (Guidelines Report) It is not really possible to summarize the report here, but the primary criteria which the IOM established for a good guideline include that it is based on a systematic review of the existing evidence; it is developed by a knowledgeable, multidisciplinary panel of experts and representatives from affected groups; it considers relevant patient subgroups and preferences; it was created by an explicit and transparent process that minimizes biases and conflicts of interest; it explains the relationship between treatment options and outcomes and rates the strength of the recommendation and the quality of the evidence behind it; and the guideline is continually updated through a review of new evidence and research.

The second report is called Finding What Works in Health Care, and has standards for doing systematic reviews.  (Research Review Report) As noted above these systematic reviews are typically the basis for guidelines so their quality is important.  The Institute has a total of 21 standards with 81 elements for judging or conducting systematic reviews.  Important steps include creating an appropriate review team and minimizing the risk of bias or conflicts in the reviewers or the process; finding and assessing individual studies, including the strength of the study’s design and statistical analysis; synthesizing the body of evidence, including conducting meta-analyses if appropriate and feasible; and reporting the outcome of the review.  These two books are an important contribution to the development of evidence-based medicine.