Table 1:

Strengths and limitations of 3 pragmatic methods for testing clinical practice guidelines

MethodStrengthsLimitationsGuideline developers currently using this method
Public consultations
  • Incorporates feedback from front-line clinicians

  • Increases acceptance from the medical community

  • Extends the length of time for guideline development

  • National Institute of Clinical Studies (Australia)

  • United States Preventive Services Task Force

  • Scottish Intercollegiate Guidelines Network

  • National Institute for Health and Clinical Excellence (UK)

Clinical vignettes
  • Requires minimal resources

  • Provides rapid feedback

  • Allows different formats of recommendations to be tested

  • Requires a group of physicians as study participants

  • Must be carefully constructed and linked to explicit outcomes or evidence-based guidelines

  • May not reflect actual behaviours of clinicians

  • None

Performance measures
  • Quality of medical care can be gauged

  • Feedback is available only after guidelines have been implemented

  • Performance measures do not always reflect the quality of care

  • Unmeasured aspects of care could worsen

  • Canadian Task Force on Preventive Health Care

  • Canadian Stroke Network

  • National Institute for Health and Clinical Excellence (UK)