Chest
Volume 144, Issue 2, August 2013, Pages 381-389
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Commentary
Creating Clinical Practice Guidelines We Can Trust, Use, and Share: A New Era Is Imminent

https://doi.org/10.1378/chest.13-0746Get rights and content

Standards and guidance for developing trustworthy clinical practice guidelines are now available, and a number of leading guidelines adhere to the key standards. Even current trustworthy guidelines, however, generally suffer from a cumbersome development process, suboptimal presentation formats, inefficient dissemination to clinicians at the point of care, high risk of becoming quickly outdated, and suboptimal facilitation of shared decision-making with patients. To address these limitations, we have—in our innovative research program and nonprofit organization, MAGIC (Making GRADE the Irresistible Choice)—constructed a conceptual framework and tools to facilitate the creation, dissemination, and dynamic updating of trustworthy guidelines. We have developed an online application that constitutes an authoring and publication platform that allows guideline content to be written and structured in a database, published directly on our web platform or exported in a computer-interpretable language (eg, XML) enabling dissemination through a wide range of outputs that include electronic medical record systems, web portals, and applications for smartphones/tablets. Modifications in guidelines, such as recommendation updates, will lead to automatic alterations in these outputs with minimal additional labor for guideline authors and publishers, greatly facilitating dynamic updating of guidelines. Semiautomated creation of a new generation of decision aids linked to guideline recommendations should facilitate face-to-face shared decision-making in the clinical encounter. We invite guideline organizations to partner with us (www.magicproject.org) to apply and further improve the tools for their purposes. This work will result in clinical practice guidelines that we cannot only trust, but also easily share and use.

Section snippets

A Potential Solution

In this article, we describe the conceptual framework and tools created in an innovative research program, the objective of which is to address problems in development, dissemination, and updating of trustworthy clinical practice guidelines (Table 1). The research program, Making GRADE the Irresistible Choice (MAGIC), is conducted by a multidisciplinary team of guideline developers, clinicians, methodologists, interaction designers, and programmers in close collaboration with the GRADE working

Call for Feedback and Collaboration

MAGIC provides—through collaboration with DECIDE and major international guideline organizations—potential solutions to key problems in guideline development, dissemination, and uptake. We welcome comments and suggestions from guideline organizations, clinicians, patients, and others interested in better guidelines on ways in which we can improve our conceptual approach; partner with us to directly contribute to our research and development of the tools and methodology we have outlined here.

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Vandvik served as a chapter editor and panelist on the development of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. He is also in research programs (MAGIC and DECIDE) to improve strategies for creating, disseminating and updating trustworthy guidelines. Dr Alonso-Coello served as a

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    For editorial comment see page 365

    Presented at the 9th Guideline International Network Conference, Berlin, Germany, August 2012.

    Funding/Support: Sykehuset Innlandet HF (Innlandet Hospital Trust) has provided research grants. The Norwegian Directorate of Health and Den norske legeforening (the Norwegian Medical Association) have provided grants to allow development of the tools created in MAGIC.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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