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Published 3/1/2007
Jan Wies

AAOS solicits topics for clinical practice guidelines

The need for evidence-based clinical practice guidelines is critical in today’s era of pay-for-performance and increased scrutiny of medical decision-making.

The AAOS has a Guidelines Oversight Committee (GOC) that determines which topics require guidelines and which topics are most critical to AAOS members.

The GOC has appointed workgroups that are currently developing evidence-based clinical practice guidelines on pulmonary embolism prophylaxis in orthopaedic hip and knee surgery and diagnosis of carpal tunnel syndrome. These guidelines should be released shortly.

The GOC has also established specific processes for nominating and selecting guideline topics. An AAOS member who would like to propose a topic must follow the specific process and approach an approved nominating body. The nominating body will then complete a topic nomination form that can be found at http://www.aaos.org/gl_info.

The nomination form requests detailed information, which must be supported by references from published, peer-reviewed literature. The completed form should be sent to Jan Wies, manager of the Clinical Practice Guidelines Unit, at wies@aaos.org. The decision to accept a topic will be based on the information provided and reviewed by the GOC.

Avoiding scope creep
To be useful, clinical practice guidelines must be timely, well-defined, and focused. Gradually adding on to the scope of a guideline (scope creep) impedes the ability to create a useful, timely product. For example, a single guideline will rarely address both the diagnosis and treatment of a musculoskeletal condition. Instead, there will be one guideline on diagnosis and a second on treatment.

For this reason, the AAOS requests very specific suggestions (a specific patient population, treatment, or diagnostic modality) for guideline topics. All nominations are reviewed by AAOS staff, who will also conduct preliminary literature searches on the topic. The GOC will makes its decision when it meets (twice a year), and staff will notify nominators within a week of that decision.

Specialty society involvement
Some specialty societies may wish to develop their own guidelines, with assistance from AAOS staff (for example, in preparing evidence tables). Specialty societies requesting AAOS staff assistance must submit a completed topic nomination form to AAOS. Decisions on whether AAOS staff will be able to assist specialty societies will be made by the GOC.

Specialty societies that wish to collaborate with AAOS or that wish to use AAOS resources in preparing guidelines must use the AAOS methodology and processes for guideline development. AAOS director of research and scientific affairs Charles Turkelson, PhD, can provide information about these processes and methodology. Specialty societies can contact him at (847) 384-4326 or turkelson@aaos.org

Topic selection criteria
The GOC considers the following questions when making its decisions:

  • Does the health problem in question carry a high individual or population burden of morbidity, mortality, or disability?
  • Does the health problem and/or its diagnosis and/or treatment carry a high unit oraggregate cost?
  • Are there substantial variations in the diagnosis and/or treatment of the health problem?
  • Are there existing guidelines on this topic? If so, will a newly developed guideline have a meaningful impact on clinical decision-making/clinical outcomes, and/or reduce practice variation, and/or be of significant benefit to AAOS members?
  • Are there sufficient research findings available on which to base a clinical practice guideline?
  • Is there substantial public or political demand for this practice guideline?
  • Is performing this guideline feasible with current AAOS resources?

The next meeting of the Guidelines Oversight Committee will be in fall, 2007. For more information on the committee and its efforts, visit the research section of the AAOS Web site: www.aaos.org/research

Who can nominate a topic?
Topics can be nominated only by the following entities:

  • AAOS Board of Councilors
  • AAOS Committees
  • AAOS Councils
  • Orthopaedic Specialty Societies and/or the Board of Orthopaedic Specialty Societies (BOS)
  • AAOS Advisory Boards
  • AAOS Communications Cabinet

Topic nominations from individuals, industry, or any other entity will not be accepted. Nominations from orthopaedic specialty societies should be submitted to AAOS by the chair of a Committee, Council, or similar entity of that society. Nominations can also be submitted by a designated member of the Boards of Directors of specialty societies.