Report: Evidence-Based Clinical Guideline Development and Application

This report examines the 'Clinical Practice Guidelines: Directions for a New Program' developed by the Institute of Medicine in the United States. It explores the guideline's development strategy, including the involvement of public and private members and funding from agencies like the Health Care Policy and Research. The report highlights the guideline's focus on determining diseases, disorders, and health conditions, along with clinical management and treatment approaches. The analysis covers the guideline's recommendations, their clinical relevance in patient care, and the use of systematic reviews to ensure quality and improved health outcomes. The report also discusses the guideline's influence on healthcare decisions, its impact on various diseases such as HIV/AIDS, diabetes, and hypertension, and its role in shaping standards of care. The conclusion emphasizes the evolving nature of guideline development and the importance of evidence-based research in establishing global standards.

Running head: EVIDENCE BASED CLINICAL GUIDELINE
Evidence Based Clinical Guideline
Name of Student:
Name of University:
Author’s Note:

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Introduction
The major aim of the essay to study the evidence based practice guideline operating in
United States. The chosen guideline is titled as “Clinical Practice Guidelines: Directions for a
New Program” developed by the Institute of Medicine. The guideline focus on the determination
of the disease, disorder, and health condition of the various disease and ways to manage and treat
it clinically. The essay has also highlighted the development strategy of the guidelines and its
funding agency for its making. The essay also speaks about the reproducibility, authenticity and
strength to get improved health outcome. Further the essay reflects the recommendations made
and it’s clinically relevancy in treating and taking care of the patients.
Development of the Guideline
The clinical practice guideline to measure the quality of care was developed in the year
1991 by the Institute of Medicine, United States. They published the guideline as a report tilted
“Clinical Practice Guidelines: Directions for a New Program”. The Institute of Medicine
appointed the other committee in the year 1990 which involved both public and private member
to develop the guideline (Bhaumik, 2017). Public member were practicing physicians,
experienced person and experts, users of the guideline and staffs of nursing, law, and economics.
Among the group of medicals American academy of family and physicians, American college of
cardiology and physicians and American society of anesthesiologist were included. The
developer of the guideline were the representative of key stakeholders in the areas of health care.

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Funding
Agency for Health Care Policy and Research approached to Institute of Medicine, United
States to implement the evidence based practice guideline. Initially the guideline was facing the
issue of high cost and doubts regarding the value of expenditure in making the policy for health
care. In the year 1990, May Institute of Medicine, United States started the project which was of
18 month duration which include the evidence based practice guideline for health care. The
project was funded by John A. Hartford Foundation and Public Health Service in order to
examine the both public and private activities to develop the guidelines. Among the developers
of guideline the members of American college of cardiology, American college of physician and
American society of anesthesiologist was the funded researcher of reviewed studies.
Development Strategy
The team had valid development strategy. They conceptualized the strategy in three basic
stages that includes development, intervention and evaluation as the important and pioneer plan
to develop evidence based clinical practice guidelines. They also viewed that second and third
stages of guideline is flexible to change in accordance with the error, technical obsolescence and
different related problems. Thus, the guideline development is dynamic and need to be updated
in time and need (Mercuri et al., 2015).
The making of the guidelines for clinical evidence based practice has included the expert
members. The decision was made according to the cultural difference of the peoples of United
States. The process of making the guideline requires professional licensure, board certification
and assurance of the quality and review the utilization of the aspect of health service
administration (Postelnicu, Rhodes & Evans, 2018). The policy maker has not overlooked the

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capability of practice guidelines as the foundation for rejecting payment for unsuitable care. The
method used here are sensible and impartial. The identification of the guideline was based on the
interest and need of the common people and community. The selection of policy and initiative
are done by reviewing the current status of the health sector. Many experts were included for its
evaluation as mentioned in above.
Method of Development of Guideline
The evidence of result of HIV/AIDS in people of US was taken as the epicentre for
making of the policy. The activist of HIV/AIDS in US continually contended the clinical trials as
the point of clinical care and scientific study. The guideline on evidence based practice has
included above mentioned evidence and the developer of the guideline has done comprehensive,
reproducible research and literature review within the past 12 months of its publication.
Systematic literature review for the published and unpublished data of the evidence were done
critically and examined its quality and authenticity. On such basis an evidence summary was
generated to for the guidelines and interventions. This evaluation has allowed the developer of
the guidelines to make judgement regarding the utility and acceptability of the guideline based
on the quality of evidence collected through literature review.
They have included all the important options and outcome. The developer has included
and used the systematic review which focuses on the health acre intervention, diagnostic tests.
They has included the prognostic marker and done the analysis on cost effectiveness of the
guidelines. Through such inclusion in making the policy, developer has also evaluated the
outcome of on the health care sector by making of the guideline. The research made by them

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helped to simplify the understanding of the guideline that can be setup in the health sector with
the outcome of good quality and improved health of peoples.
In order to understand the possible options and outcome conceptual framework was made
which included a guideline development, evaluation, health system actors, dissemination,
implementation of the methodology and improved health outcome. Thus, it can be said that the
guideline has been subjected to critical peer review and testing. For such evaluation, national and
local member were also considered.
Recommendation
The clinical practice guideline has included the structure by which the quality of care can
be measure. “Clinical Practice Guidelines: Directions for a New Program” provide various
recommendation that are used in making the decision within the clinical areas as well as within
the health care system of the United States. It can be further said that use of research evidence
for making the recommendation which is highlighted in the guideline is of global value to
confirm the quality of the guidelines (Sturgiss, Douglas, Kathage & Res, 2016).
Thus, the recommendations made are clinically relevant for improved health outcome of the
people. The recommendation made by the developer and clinical experts are regularly in conflict
with the finest obtainable research evidence.
“Clinical Practice Guidelines: Directions for a New Program” has provided
recommendation regarding the diagnosis and treatment of the people suffering from ADIS,
diabetes mellitus, dyslipidemia and hypertension. (Whelton, 2019). The treatment
recommendation for such disease has been advocated which has included the use of equipment

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and health staffs. The above guideline also recommend about the ways to manage the
cardiovascular risks among the people of US. Total of 1005 recommendation has been made that
can be employed by the physician, educators and practitioner in order to regulate the disease and
disorders effectively and appropriately. The disease can be managed, prevented, treated and
diagnosed clinically. The clinical recommendation can help in caring of the patients suffering
from diabetes, cardiovascular disease, hypertension and other unidentified disease. The
recommendations given are practical enough for its implementation. From the above discussion
it can be said that it is not much different from the current practice and outcome can be measured
as standard of care.
Conclusion
Lastly, from the above discussion it can be said that the guideline development has
underwent changes in the past few years. The major reason being the continuous evidence based
research in the form of systematic reviews. The research has provided ways to formulate
recommendations to become the global standard of care of people. The quality of the guidelines
used in the United States and the way by which evidence are used in expressing it and the
obstacles to acceptance of the evidence are gap in research which need to be done in future.

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Reference
Bhaumik, S. (2017). Use of evidence for clinical practice guideline development. Tropical
parasitology, 7(2), 65. Retrieved from https://dx.doi.org/10.4103%2Ftp.TP_6_17
Mercuri, M., Sherbino, J., Sedran, R. J., Frank, J. R., Gafni, A., & Norman, G. (2015). When
guidelines don’t guide: the effect of patient context on management decisions based on
clinical practice guidelines. Academic Medicine, 90(2), 191-196. Retrieved from doi:
10.1097/ACM.0000000000000542
Postelnicu, R., Rhodes, A., & Evans, L. (2018). International Clinical Practice Guidelines.
In Handbook of Sepsis (pp. 97-111). Springer, Cham. Retrieved from DOI 10.1007/978-
3-319-73506-1_7
Sturgiss, E., Douglas, K., Kathage, R., & Res, S. (2016). A synthesis of selected national
Australian guidelines on the general practice management of adult patients who are
overweight or obese extc1. Retrieved from http://hdl.handle.net/1885/152742
Whelton, P. K. (2019). Evolution of blood pressure clinical practice guidelines: a personal
perspective. Canadian Journal of Cardiology. Retrieved from
https://doi.org/10.1016/j.cjca.2019.02.019