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Developing clinical practice guidelines: reviewing, reporting, and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development

Paul Shekelle12*, Steven Woolf3, Jeremy M Grimshaw45, Holger J Schünemann6 and Martin P Eccles7

Author Affiliations

1 RAND Corporation, Santa Monica, CA 90407, USA

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

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

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

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

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

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

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Implementation Science 2012, 7:62  doi:10.1186/1748-5908-7-62

Published: 4 July 2012


Clinical practice guidelines are one of the foundations of efforts to improve health care. 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 clearing houses 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 third paper we discuss the issues of: reviewing, reporting, and publishing guidelines; updating guidelines; and the two emerging issues of enhancing guideline implementability and how guideline developers should approach dealing with the issue of patients who will be the subject of guidelines having co-morbid conditions.