Is GRADE the Right Choice for Clinical Practice Guidelines Developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation?

2019 ◽  
Vol 161 (1) ◽  
pp. 3-5
Author(s):  
Andrés M. Bur ◽  
Richard M. Rosenfeld
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Current Knowledge ◽  
Clinical Care ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
The Right

Clinical practice guidelines (CPGs), developed to inform clinicians, patients, and policy makers about what constitutes optimal clinical care, are one way of increasing implementation of evidence into clinical practice. Many factors must be considered by multidisciplinary guideline panels, including strength of available evidence, limitations of current knowledge, risks/benefits of interventions, patient values, and limited resources. Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a framework for summarizing evidence that has been endorsed by many national and international organizations for developing CPGs. But is GRADE the right choice for CPGs developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF)? In this commentary, we will introduce GRADE, discuss its strengths and limitations, and address the question of what potential benefits GRADE might offer beyond existing methodology used by the AAO-HNSF in developing CPGs.

Quality Improvement in Otolaryngology–Head and Neck Surgery: Developing Registry-Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process

2021 ◽  
pp. 019459982110119
Author(s):  
Jeremy J. Michel ◽  
Seth R. Schwartz ◽  
Douglas E. Dawson ◽  
James C. Denneny ◽  
Eileen Erinoff ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Practice ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Care ◽  
Quality Measures ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Quality Reporting

Background and Significance Quality measurement can drive improvement in clinical care and allow for easy reporting of quality care by clinicians, but creating quality measures is a time-consuming and costly process. ECRI (formerly Emergency Care Research Institute) has pioneered a process to support systematic translation of clinical practice guidelines into electronic quality measures using a transparent and reproducible pathway. This process could be used to augment or support the development of electronic quality measures of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) and others as the Centers for Medicare and Medicaid Services transitions from the Merit-Based Incentive Payment System (MIPS) to the MIPS Value Pathways for quality reporting. Methods We used a transparent and reproducible process to create electronic quality measures based on recommendations from 2 AAO-HNSF clinical practice guidelines (cerumen impaction and allergic rhinitis). Steps of this process include source material review, electronic content extraction, logic development, implementation barrier analysis, content encoding and structuring, and measure formalization. Proposed measures then go through the standard publication process for AAO-HNSF measures. Results The 2 guidelines contained 29 recommendation statements, of which 7 were translated into electronic quality measures and published. Intermediate products of the guideline conversion process facilitated development and were retained to support review, updating, and transparency. Of the 7 initially published quality measures, 6 were approved as 2018 MIPS measures, and 2 continued to demonstrate a gap in care after a year of data collection. Conclusion Developing high-quality, registry-enabled measures from guidelines via a rigorous reproducible process is feasible. The streamlined process was effective in producing quality measures for publication in a timely fashion. Efforts to better identify gaps in care and more quickly recognize recommendations that would not translate well into quality measures could further streamline this process.

Tonsillektomia w populacji pediatrycznej – główne wskazania, aktualne wytyczne Amerykańskiej Akademii Otolaryngologów Chirurgów Głowy i Szyi

2019 ◽  
Vol 23 (4) ◽  
Author(s):  
Anna Wierzbicka-Rot ◽  
Artur Gadomski
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Postoperative Care ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Evidence Based ◽  
Practical Information

In February 2019 American Academy of Otolaryngology-Head and Neck Surgery published clinical practice guidelines which provides evidence-based recommendations that applies to children under consideration for tonsillectomy. This update to the 2011 publication includes large amount of new, practical information about pre-, intra- and postoperative care and management, that can be useful for surgeons as well as GPs and pediatricians

Adherence to American Academy of Otolaryngology–Head and Neck Surgery Clinical Practice Guidelines: A Systematic Review

2020 ◽  
Vol 163 (4) ◽  
pp. 626-644
Author(s):  
Marisa A. Ryan ◽  
Grace R. Leu ◽  
Emily F. Boss ◽  
Eileen M. Raynor ◽  
Jonathan M. Walsh
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Otitis Media ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Otitis Media With Effusion ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Publication Date

Objective Clinical practice guidelines synthesize and disseminate the best available evidence to guide clinical decisions and increase high-quality care. Since 2004, the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) has published 16 guidelines. The objective of this review was to evaluate clinicians’ adherence to these guidelines’ recommendations as measured in the literature. Data Sources We searched PubMed, Embase, and Web of Science on August 29, 2019, for studies published after June 1, 2004. Review Methods We systematically identified peer-reviewed studies in English that reported clinician adherence to AAO-HNSF guideline recommendations. Two authors independently reviewed and abstracted study characteristics, including publication date, population, sample size, guideline adherence, and risk of bias. Results The search yielded 385 studies. We excluded 331 studies during title/abstract screening and 32 more after full-text review. The remaining 22 studies evaluated recommendations from 8 of the 16 guidelines. The Otitis Media with Effusion, Polysomnography, Tonsillectomy, and Sinusitis guidelines were studied most. Study designs included retrospective chart reviews (7, 32%), clinician surveys (7, 32%), and health care database analyses (8, 36%). Studies reported adherence ranging from 0% to 99.8% with a mean of 56%. Adherence varied depending on the recommendation evaluated, type of recommendation, clinician type, and clinical setting. Adherence to the polysomnography recommendations was low (8%-65.3%). Adherence was higher for the otitis media with effusion (76%-90%) and tonsillectomy (43%-98.9%) recommendations. Conclusions Adherence to recommendations in the AAO-HNSF guidelines varies widely. These findings highlight areas for further guideline dissemination, research about guideline adoption, and quality improvement.

Clinical Practice Guidelines: AAO-HNSF Process for CPG Development and Topic Selection

2017 ◽  
Vol 158 (2) ◽  
pp. 219-221
Author(s):  
Sukgi Choi ◽  
Lorraine Nnacheta
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
The Public ◽  
Selection Of

The American Academy of Otolaryngology–Head and Neck Surgery has been developing clinical practice guidelines (CPGs) for use by its members and the public. The process of CPG development and the selection of topics for CPGs can be confusing. This commentary attempts to clarify this process and delineate the issues that are considered in topic selection.

Hypertension and Epistaxis: Why Is There Limited Guidance in the Nosebleed Clinical Practice Guidelines?

2020 ◽  
Vol 162 (1) ◽  
pp. 33-34 ◽  
Author(s):  
Spencer C. Payne ◽  
David Feldstein ◽  
Samantha Anne ◽  
David E. Tunkel
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Multivariate Analyses ◽  
Relevant Literature ◽  
Neck Surgery

Hypertension has long been thought to influence the risk and severity of epistaxis. However, evaluation of the relevant literature reveals articles with methodologic concerns or limited quality. In many instances, these studies are not adequately controlled, and lack of multivariate analyses calls into question any noted association between epistaxis and hypertension. The goal of this commentary is to explain why there is limited guidance about the management of hypertension and the possible association with nosebleed in the 2020 American Academy of Otolaryngology–Head and Neck Surgery Foundation clinical practice guideline for nosebleeds. Background on the literature that describes the association between hypertension and nosebleeds is provided.

Appraising Otolaryngology–Head and Neck Surgery Clinical Practice Guidelines for Effective Dissemination and Implementation Design

2020 ◽  
Vol 163 (2) ◽  
pp. 209-215 ◽  
Author(s):  
John P. Flynn ◽  
Jennifer A. Villwock ◽  
Alexander G. Chiu ◽  
Kevin J. Sykes
Keyword(s):  
Clinical Practice ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Applicability Domain ◽  
Dissemination And Implementation ◽  
Agree Ii ◽  
Agree Ii Instrument

Objectives Dissemination and implementation (D&I) science analyzes interventional strategies that aid in spreading scientific knowledge, adopting evidence into practice, and identifying barriers to maximize successful integration of science into practice. This study set out to critically appraise the published D&I strategies of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) Clinical Practice Guidelines (CPGs) and to introduce the theories of D&I science. Methods The 15 AAO-HNSF CPGs underwent appraisal by 2 independent reviewers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. CPGs were rated over 23 key items in 6 domains. Each item was rated on a 7-point scale from 1 ( strongly disagree) to 7 ( strongly agree). CPGs were rated and quality assessments were performed. Intrarater reliability was assessed. Results The overall mean score of the CPGs was 85.2% (95% confidence interval, 83.4%-86.9%). Individual CPG mean scores ranged from 80.4% to 90.9%. Mean interrater reliability was strong. All domains of the AGREE II instrument, except the Applicability domain, scored a mean of 90.7% or better. D&I strategies within the CPGs, as calculated by the Applicability domain score, ranged from 22.9% to 77.1%. Discussion There is a paucity of published D&I strategies within the AAO-HNSF CPGs. Nesting a D&I framework, such as the Quality Improvement Framework, within CPGs would allow for identification of barriers to CPG adoption and evaluation of CPG-directed interventions. Implications for Practice A D&I framework within the AAO-HNSF CPGs would allow for objective measurement of the overall impact of CPGs on otolaryngology practices.

scholarly journals Evaluation of Compliance for Treatment of Sudden Hearing Loss

2016 ◽  
Vol 155 (1) ◽  
pp. 48-55 ◽  
Author(s):  
David L. Witsell ◽  
Tawfiq Khoury ◽  
Kristine A. Schulz ◽  
Robert Stachler ◽  
Debara L. Tucci ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Neck Surgery ◽  
Sudden Hearing Loss ◽  
Head And Neck Surgery ◽  
Community Based

Objective The objective of this study is to describe the presentation and management of sudden sensorineural hearing loss for patients seen in academic and community-based practices within the context of the American Academy of Otolaryngology—Head and Neck Surgery Foundation’s “Clinical Practice Guideline: Sudden Hearing Loss.” The intention is to use these findings to guide implementation strategies and quality improvement initiatives and as pilot data for the development of clinical research initiatives. Study Design A cross-sectional study of patients with sudden hearing loss. Setting Patients were recruited from practices within the Creating Healthcare Excellence through Education and Research (CHEER) network. The CHEER network is an National Institutes of Health–funded network of 30 otolaryngology sites across the country, half of which are community based and half of which are academic practices. Subjects and Methods A total of 173 patients were recruited. Data were gathered via custom questionnaires collected by study site coordinators and entered into a secure online platform. Descriptive analyses and correlation statistics were run with SAS 9.3.1. Results Of the 13 guideline statements in the American Academy of Otolaryngology—Head and Neck Surgery Foundation’s clinical practice guideline on sudden hearing loss, 11 statements were evaluable through this study. Compliance for otolaryngologists was >95% for key action statements (KASs) 1, 3, and 6; 90% to 95% for KASs 5 and 10; and <90% for KASs 7 and 13. Compliance was <45% for nonotolaryngologists for KASs 3 and 5-7. Conclusions There is opportunity for nonotolaryngologists to improve for statements 3 and 5-7. Otolaryngologists are compliant with many of the KASs overall, but there is significant room for improvement.

scholarly journals Adherence to Clinical Practice Guidelines

2017 ◽  
Vol 157 (4) ◽  
pp. 548-550 ◽  
Author(s):  
Marisa A. Ryan
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Scientific Evidence ◽  
Quality Care ◽  
Neck Surgery ◽  
Relevant Research ◽  
High Quality ◽  
The Impact

Clinical practice guidelines are designed to synthesize and disseminate the best available evidence to guide clinical practice. The goal is to increase high-quality care and reduce inappropriate interventions. Clinical practice guidelines that systematically review evidence and synthesize it into recommendations are important because the available scientific evidence is normally neither rapidly nor broadly incorporated into practice. It is important to understand and improve the impact of our American Academy of Otolaryngology—Head and Neck Surgery Foundation clinical practice guidelines on this uptake of scientific knowledge. Considering the barriers to guideline adherence is a central part of this. This understanding can guide clinicians, future guideline authors, and researchers when using guidelines, writing them, and planning clinically relevant research.

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