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Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations

Steven Woolf1, Holger J Schünemann2, Martin P Eccles3, Jeremy M Grimshaw45 and Paul Shekelle67*

Author Affiliations

1 Department of Family Medicine and Center on Human Needs, Virginia Commonwealth University, Richmond, VA, USA

2 Departments of Clinical Epidemiology and Biostatistics and of Medicine, McMaster University, Hamilton, Canada

3 Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK

4 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

5 Department of Medicine, University of Ottawa, Ottawa, ON, Canada

6 RAND Corporation, Santa Monica, CA 90407, USA

7 Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA

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Implementation Science 2012, 7:61  doi:10.1186/1748-5908-7-61

Published: 4 July 2012


Clinical practice guidelines are one of the foundations of efforts to improve healthcare. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearinghouses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this second paper, we discuss issues of identifying and synthesizing evidence: deciding what type of evidence and outcomes to include in guidelines; integrating values into a guideline; incorporating economic considerations; synthesis, grading, and presentation of evidence; and moving from evidence to recommendations.