Scientific Evidence Underlying the American College of Obstetricians and Gynecologists' Practice Bulletins

OBJECTIVE: Clinical guidelines are an important source of guidance for clinicians. Few studies have examined the quality of scientific data underlying evidence-based guidelines. We examined the quality of evidence that underlies the recommendations made by the American College of Obstetricians and Gynecologists (the College). METHODS: The current practice bulletins of the College were examined. Each bulletin makes multiple recommendations. Each recommendation is categorized based on the quality and quantity of evidence that underlies the recommendation into one of three levels of evidence: A (good and consistent evidence), B (limited or inconsistent evidence), or C (consensus and opinion). We analyzed the distribution of levels of evidence for obstetrics and gynecology recommendations. RESULTS: A total of 84 practice bulletins that offered 717 individual recommendations were identified. Forty-eight (57.1%) of the guidelines were obstetric and 36 (42.9%) were gynecologic. When all recommendations were considered, 215 (30.0%) provided level A evidence, 270 (37.7%) level B, and 232 (32.3%) level C. Among obstetric recommendations, 93 (25.5%) were level A, 145 (39.7%) level B, and 117 (34.8%) level C. For the gynecologic recommendations, 122 (34.7%) were level A, 125 (35.5%) level B, and 105 (29.8%) level C. The gynecology recommendations were more likely to be of level A evidence than the obstetrics recommendations (P=.049). CONCLUSION: One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence. LEVEL OF EVIDENCE: III

[1]  Diana Petitti,et al.  Update on the Methods of the U.S. Preventive Services Task Force: Estimating Certainty and Magnitude of Net Benefit , 2007, Annals of Internal Medicine.

[2]  C. Furberg,et al.  Why guideline-making requires reform. , 2009, JAMA.

[3]  R. Go,et al.  Level of scientific evidence underlying recommendations arising from the National Comprehensive Cancer Network clinical practice guidelines. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  R. Califf,et al.  Scientific evidence underlying the ACC/AHA clinical practice guidelines. , 2009, JAMA.

[5]  Brian P. Kavanagh,et al.  The GRADE System for Rating Clinical Guidelines , 2009, PLoS medicine.

[6]  D. Lee,et al.  Analysis of overall level of evidence behind Infectious Diseases Society of America practice guidelines. , 2011, Archives of internal medicine.

[7]  G. Guyatt,et al.  GRADE: an emerging consensus on rating quality of evidence and strength of recommendations , 2008, BMJ : British Medical Journal.

[8]  A. Detsky.  Sources of bias for authors of clinical practice guidelines , 2006, Canadian Medical Association Journal.

[9]  Diana B Petitti,et al.  Update on the Methods of the U.S. Preventive Services Task Force: Insufficient Evidence , 2009, Annals of Internal Medicine.

[10]  Vincenzo Berghella,et al.  American College of Obstetricians and Gynecologists practice bulletins: an overview. , 2006, American journal of obstetrics and gynecology.

[11]  R. Grol,et al.  Inside guidelines: comparative analysis of recommendations and evidence in diabetes guidelines from 13 countries. , 2002, Diabetes care.

[12]  T. Merritt,et al.  A critical evaluation of clinical practice guidelines in neonatal medicine: does their use improve quality and lower costs? , 1999, Journal of evaluation in clinical practice.

[13]  Diane Solomon,et al.  2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. , 2007, American journal of obstetrics and gynecology.

[14]  A. Detsky,et al.  Relationships between authors of clinical practice guidelines and the pharmaceutical industry. , 2002, JAMA.

[15]  Li Zhi-gang,et al.  2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests , 2008 .

[16]  A. Wu,et al.  Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. , 2005, JAMA.

[17]  G. Guyatt,et al.  Clinical experts or methodologists to write clinical guidelines? , 2009, The Lancet.

[18]  G. Guyatt,et al.  GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. , 2011, Journal of clinical epidemiology.

[19]  Fang-Shu Ou,et al.  Pay for performance, quality of care, and outcomes in acute myocardial infarction. , 2007, JAMA.

[20]  F. McAlister,et al.  How Evidence-Based Are the Recommendations in Evidence-Based Guidelines? , 2007, PLoS medicine.

[21]  J. Landercasper,et al.  A breast center review of compliance with National Comprehensive Cancer Network Breast Cancer guidelines. , 2006, American journal of surgery.

[22]  S. Chauhan,et al.  Comparison of two national guidelines in obstetrics: American versus royal college of obstetricians and gynecologists. , 2010, American journal of perinatology.

[23]  M. V. van Driel,et al.  Differences Among International Pharyngitis Guidelines: Not Just Academic , 2007, The Annals of Family Medicine.

[24]  R. Burkman,et al.  Does Standardization of Care Through Clinical Guidelines Improve Outcomes and Reduce Medical Liability? , 2010, Obstetrics and gynecology.

[25]  R. Centor,et al.  Reassessment of clinical practice guidelines: go gently into that good night. , 2009, JAMA.

[26]  John H. Powers.  Practice guidelines: belief, criticism, and probability. , 2011, Archives of internal medicine.