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Q. What is the difference between a practice guideline and a quality measure?
A. Clinical practice guidelines are documents that include recommendations intended to optimize patient care that are based on an evidence-based systematic review. Quality measures are mathematical equations to help understand how often health care services are consistent with current medical knowledge. Guideline recommendations form the denominator and numerator statements of quality measures. 

Q. When do you update guidelines?
A. An update is considered when there is newly published evidence that significantly changes either the conclusions or the recommendations in a guideline. Guidelines and case definitions are assessed at least every three years to determine whether new literature has been published that would warrant an update. If the Guideline Subcommittee (GS) is aware of new evidence that may change conclusions or recommendations in the guideline prior to the next scheduled triennial review, the GS will review earlier.

Q. Do you collaborate with other guideline developers?
A. Medical associations and organizations regularly work together on medical practice guidelines when multiple groups or clinician specialties are involved with the treatment of a specific disease. There are two levels of collaboration:

• Full collaboration: The development panel reflects equal representation from the collaborating societies. The societies involved sign a formal letter of agreement outlining terms of copyright ownership, simultaneous publication, division of costs before project initiation, and the method to be used.
• Invited participation: Â鶹´«Ã½Ó³»­ staff works with the societies to obtain a nominee. This individual serves as the official representative from the organization, providing updates to the organization’s board of directors. The organization has the opportunity to review and comment on the guideline during public comment periods and to endorse the guideline before publication.

Additionally, the Â鶹´«Ã½Ó³»­ has several ways of endorsing or affirming the value of guidelines developed by other organizations. For more information, review the Â鶹´«Ã½Ó³»­ endorsement policy.

Q. How do you choose what guidelines to develop?
A. Guideline projects are either updates to existing guidelines that have become out of date or are new projects. Â鶹´«Ã½Ó³»­ members and others are welcome to at any time. All topic nominations are reviewed by the GS. The GS reviews and votes on nominated topics annually using a ranking tool known as the Topic Nomination Priority Score (TNPS). The following criteria are taken into account:

• Relevance to neurologists
• Disease prevalence
• Degree of practice variation or controversy
• Project feasibility (amount of evidence, Â鶹´«Ã½Ó³»­ and GS resources, whether collaboration with one or more external societies is required)
• Impact on patient care and outcomes

Not all topics are accepted for development and the GS limits the number of topics awaiting development at any one time.

Q. What information/studies will be considered and included in the guidelines?
A. Authors review all available scientific studies on the chosen topic and select studies that 1) meet the inclusion criteria and 2) address the guideline's clinical questions. Inclusion criteria and questions are set before the literature search begins. Unpublished literature (also known as grey literature), such as supplements, book chapters, and studies that are unpublished or are not included in bibliographic retrieval systems, is also included to reduce publication bias.

Q. How is the level of evidence of each study determined?
A. For Â鶹´«Ã½Ó³»­ guidelines, the risk of bias in studies is measured using a four-tiered classification scheme. In this scheme, studies rated Class I are judged to have a low risk of bias; Class II, a moderate risk of bias; Class III, a moderately high risk of bias; and Class IV, a very high risk of bias. The classification rating is also known as the level of evidence.

Q. What is GRADE?
A. GRADE stands for “Grading of Recommendations Assessment, Development and Evaluation.” GRADE is a transparent approach to grading the quality of evidence and strength of recommendations. The methodology is designed to help clinicians understand the strength of the science backing treatment recommendations, minimizing bias and aiding them in their interpretation.

Q. Who is on guideline development panels and how were they chosen?
A. Panels include members of the GS, an evidence-based medicine methodologist, neurologist subject matter experts, non-neurologists subject matter experts, representatives from physician and patient organizations, and patient representatives. The GS leadership reviews and approves all panel members. The lead author and over half of the members of the development panel cannot have conflicts of interest.