Clinical Practice Guidelines: The Warped Incentives in the U.S. Healthcare System

2011 ◽  
Vol 37 (1) ◽  
pp. 7-40 ◽  
Author(s):  
Ronen Avraham
Keyword(s):  
Clinical Practice ◽  
Healthcare System ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cognitive Biases ◽  
Conflicts Of Interest ◽  
State Legislatures ◽  
Private Regulation ◽  
Revolving Doors ◽  
Tort System

The healthcare system is sick. The players are incentivized to maximize their own benefit and externalize their costs onto the other parties. This paper examines the warped incentives that underlie the system. The tort system, lacking expertise and slow to adapt, is unable to overcome cognitive biases to adequately solve the problems. Clinical practice guidelines could pose a solution, but not as they are currently developed. Guidelines promulgated by healthcare associations are infected by a web of conflicts of interest with every player in the industry. Government agencies, and their revolving doors, are underfunded and also subject to the industry's web of conflicts. Even if adequate guidelines could consistently be produced, state legislatures and courts have been unwilling and unable to substantially incorporate guidelines into the legal landscape. Lastly, this article proposes a private regulation regime that could be a solution which would align all of the players' incentives to society's interests.

scholarly journals Transparency ethics in practice: Revisiting financial conflicts of interest disclosure forms in clinical practice guidelines

PLoS ONE ◽  
2017 ◽  
Vol 12 (8) ◽  
pp. e0182856 ◽  
Author(s):  
Yidan Lu ◽  
Derek J. Jones ◽  
Nour Sharara ◽  
Tonya Kaltenbach ◽  
Loren Laine ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Conflicts Of Interest ◽  
Financial Conflicts Of Interest

scholarly journals Conflicts of Interest in Clinical Practice Guidelines: Accelerating an Evolution. An Endocrine Society Consensus Statement*

2018 ◽  
Vol 103 (12) ◽  
pp. 4339-4342 ◽  
Author(s):  
Christopher R McCartney ◽  
Clifford J Rosen
Keyword(s):  
Clinical Practice ◽  
Best Practices ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Development Process ◽  
Consensus Statement ◽  
Conflicts Of Interest ◽  
Best Interests ◽  
Endocrine Society ◽  
Open Payments

Abstract An analysis of the Endocrine Society’s clinical practice guidelines (CPGs) published from 2010 to 2017—presented by Irwig et al. in the current issue of The Journal of Endocrinology and Metabolism—suggested that the Endocrine Society met five of seven National Academy of Medicine (NAM) standards concerning financial conflicts of interest in CPGs. As current contributors to the Endocrine Society’s CPG efforts, we offer additional context related to the 2011 NAM standards and the current environment concerning industry support in medicine, and we comment on the nature of industry support received by the Society’s CPG authors according to Irwig and colleagues’ analysis of the Centers for Medicare and Medicaid Services’ Open Payments database. Perhaps most importantly, we outline the Society’s recent and ongoing efforts to enhance the value of its CPGs. Such efforts include a 2016 revision of CPG author conflict of interest rules—a change that was invisible to the investigatory methods used by Irwig et al.—in addition to other processes designed to enhance CPG objectivity. We conclude our commentary by recognizing that good-faith attempts to enhance transparency and to reduce conflicts of interest (real or apparent) in CPGs will ultimately serve the best interests of patients and providers; we confirm the Endocrine Society’s resolute commitment to providing high-quality, evidence-based clinical guidance via a CPG development process that faithfully accords with current CPG best practices.

scholarly journals Managing conflicts of interest in clinical practice guidelines

2020 ◽  
Vol 91 (2) ◽  
pp. 274-275
Author(s):  
Sachin Wani ◽  
John Vargo ◽  
Michael Wallace
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Conflicts Of Interest

scholarly journals The structure of the quality of clinical practice guidelines with the items and overall assessment in AGREE II: a regression analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yosuke Hatakeyama ◽  
Kanako Seto ◽  
Rebeka Amin ◽  
Takefumi Kitazawa ◽  
Shigeru Fujita ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Conflicts Of Interest ◽  
Agree Ii ◽  
Domain 3 ◽  
Based Medicine ◽  
The Relationship

Abstract Background The Appraisal of Guidelines for Research & Evaluation (AGREE) II has been widely used to evaluate the quality of clinical practice guidelines (CPGs). While the relationship between the overall assessment of CPGs and scores of six domains were reported in previous studies, the relationship between items constituting these domains and the overall assessment has not been analyzed. This study aims to investigate the relationship between the score of each item and the overall assessment and identify items that could influence the overall assessment. Methods All Japanese CPGs developed using the evidence-based medicine method and published from 2011 to 2015 were used. They were independently evaluated by three appraisers using AGREE II. The evaluation results were analyzed using regression analysis to evaluate the influence of 6 domains and 23 items on the overall assessment. Results A total of 206 CPGs were obtained. All domains and all items except one were significantly correlated to the overall assessment. Regression analysis revealed that Domain 3 (Rigour of Development), Domain 4 (Clarity of Presentation), Domain 5 (Applicability), and Domain 6 (Editorial Independence) had influence on the overall assessment. Additionally, four items of AGREE II, clear selection of evidence (Item 8), specific/unambiguous recommendations (Item 15), advice/tools for implementing recommendations (Item 19), and conflicts of interest (Item 22), significantly influenced the overall assessment and explained 72.1% of the variance. Conclusions These four items may highlight the areas for improvement in developing CPGs.

scholarly journals Protocol of an interdisciplinary consensus project aiming to develop an AGREE II extension for guidelines in surgery

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037107
Author(s):  
George A Antoniou ◽  
Dimitris Mavridis ◽  
Sofia Tsokani ◽  
Manuel López-Cano ◽  
Iván D Flórez ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Conflicts Of Interest ◽  
Guideline Development ◽  
Reporting Quality ◽  
Consensus Conference ◽  
Professional Staff ◽  
Delphi Panel ◽  
Agree Ii

IntroductionAppraisal of Guidelines for Research and Evaluation (AGREE II) is an instrument that informs development, reporting and assessment of clinical practice guidelines. Previous research has demonstrated the need for improvement in methodological and reporting quality of clinical practice guidelines specifically in surgery. We aimed to develop an AGREE II extension document for application in surgical guidelines.Methods and analysisWe have performed a structured literature review and assessment of guidelines in surgery using the AGREE II instrument. In exploratory analyses, we have identified factors associated with guideline quality. We have performed reliability and factor analyses to inform the development of an extension document. We will summarise this information and present it to a Delphi panel of stakeholders. We will perform iterative Delphi rounds and we will summarise the final results to develop the extension instrument in a dedicated consensus conference.Ethics and disseminationFunding bodies will not be involved in the development of the instrument. Research ethics committee and Health Research Authority approval was waived, since this is a professional staff study only and no duty of care lies with the National Health Service to any of the participants. Conflicts of interest, if any, will be addressed by reassigning functions or replacing participants with relevant conflicts. The results will be disseminated through publication in peer reviewed journals, the funders’ websites, social media and direct contact with guideline development organisations and peer-reviewed journals that publish guidelines.

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