New tool to assess usefulness of clinical guidelines for patient outcomes

A team of researchers at Tufts University School of Medicine and colleagues have developed a new tool, G-TRUST (the Guideline Trustworthiness, Relevance, and Utility Scoring Tool) to help clinicians assess the usefulness of clinical guidelines in the treatment of their patients. The related study is published today in Annals of Family Medicine.

Recommended guidelines are typically the result of evidence-based medical protocols developed by physicians regarded as experts in their respective fields and are among the important inputs that physicians employ when diagnosing patients and designing treatment plans. Guidelines are generally codified and published by physician professional organizations and medical governing bodies and widely used as recommended standard practice across the United States and many other countries. However, there can be many practice guidelines available in a specific clinical context, not all of which may be useful.

"In every medical specialty, physicians are required to review multiple sets of practice guidelines to determine their usefulness for a specific patient's treatment. Such tools are often developed primarily for research and further guideline development rather than direct clinical application," said first and corresponding author Allen Shaughnessy, Pharm.D., M.Med.Ed., professor at Tufts University School of Medicine and fellowship director of the Tufts University Family Medicine Residency Program at Cambridge Health Alliance.

As an aid to practicing clinicians, the research team developed a straightforward eight-point tool for scoring clinical guidelines to assess their usefulness that can be applied in a clinical setting.

"The goal of this project was to develop a simple, easy-to-use tool for clinicians to identify trustworthy, relevant, and useful practice guidelines," he continued.

The result of this effort, the G-TRUST tool, was developed using a modified Delphi process to obtain consensus of a panel of experts including 22 experts in evidence-based medicine, 17 developers of high-quality guidelines, and one consumer representative. To prepare the Delphi panel, the research team reviewed publications from the Health and Medicine Division of the National Academy of Medicine (NAM, formerly the Institute of Medicine, and now part of the National Academies of Sciences, Engineering, and Medicine) as well as their own prior research and other research on clinical guidelines. The Delphi panel examined the resulting checklist of assessment items and rated the relative impact of each item on guideline quality. The research group conducted four rounds of Delphi review to refine wording, add and subtract items, and develop a scoring system.

Using the Delphi expert consensus, the team created an eight-item checklist designed to help clinicians quickly identify useful guidelines that can be used in the clinic.

"Our instrument identified almost all (92 percent) of the 'low quality' guidelines and, based on our tighter definition of trustworthiness, disqualified many that previously were considered to be of 'high quality,'" said last author Lisa Cosgrove, Ph.D., professor of psychology at the University of Massachusetts Boston, adding, "The items in G-TRUST address issues and concerns voiced by the NAM report and other critiques of existing clinical guidelines."