The
AAO Compendium of Evidence-Based Eye Care™ will be a collection of clinical practice guidelines based on clinical evidence and expert consensus to assist the clinician in decision-making about treating specific diseases. The successful implementation of such clinical guidelines should improve quality of care by decreasing inappropriate variation and by expediting the application of effective advances into everyday practice.
The challenge before us is making new information and evidence more easily and readily available to the busy practitioner. The sheer volume of evidence is overwhelming for most practitioners. As a result, only 50 percent of patient care is based on evidence-based medicine, and there is, on average, a 12-year lag for the adoption of results from randomized controlled trials into clinical practice. Making the results of the latest and most reliable clinical evidence readily available to the busy practitioner is a key objective for the development of the AAO Compendium of Evidence-Based Eye Care™.
The purpose of the Compendium is to create a single on-line resource for the profession to obtain evidence-based and expert consensus-based clinical practice guidelines in order to provide guidance in the management of patients. In addition, the Compendium would also be used as a template for performance measures in pay for performance and maintenance of certification. These two requirements should be linked.
The structure of the Compendium will be in two sections based on the process used to create the Guideline:
- Section A: Evidence-Based Guidelines that have gone through a full systematic review and analysis of the literature with a rating of the evidence by a trained methodologist, followed by a meeting of experts to reach consensus on recommendations where no level 1 evidence exists.
- Section B: Consensus-Based Guidelines that are developed by a panel of experts that may be based on findings in the literature and clinical experience, but have not gone through the full literature review process and analysis by a methodologist.
Sources for the content in the Compendium will include:
- AAO Preferred Practice Patterns and Summary Benchmarks
- AAO Clinical Statements
- Other AAO educational products (BCSC, Focal Points, etc.)
- Subspecialty society clinical guidelines and statements
- Practicing Ophthalmologist Curriculum
- Clinical trials
- International societies (International Council on Ophthalmology)
- Supranational societies and national societies
Process for Guideline Formation
Process for inclusion in the AAO Compendium for Evidence-Based Eye Care:
Subspecialty society creates a committee (minimum 5 members) to develop guideline documents. This committee may include a member of the POC panel and a member of the PPP panel from their subspecialty area, or they may serve ex-officio to provide some guidance to the committee. This committee undertakes the following tasks:
- Choose disease entities, patient populations, and intervention using the POC as the most clinically relevant source of potential guideline topics
- Create a draft guideline document in the summary benchmark format
**The following two steps (3 and 4) are optional but NECESSARY if evidence-based ratings are given to each recommendation and for the Guideline to be listed in the Evidence-Based portion of the Compendium (Section A – see above): - Perform literature search including all relevant AAO educational products (Subspecialty Society (literature), AAO staff (AAO Products) or Cochrane)
- Evaluate existing evidence and rate quality of each study by a trained methodologist. (Society must provide funding or sponsorship for this activity.)
- Modify process of care elements and make recommendations based on available evidence and panel consensus
- Work within subspecialty to refine the guideline and consider comments
- PPP panel chair and/or POC panel chair would review the guideline content and methodology and, if approved, would forward to the Academy Board of Trustees
- If approved by the Board (consent agenda), the guidelines would be added to the Compendium in the appropriate section
Template for clinical guidelines
- Establishing the diagnosis (clinical and lab)
- Risk factors
- Differential diagnosis
- Management (medical, surgical and follow-up)
- Treatment complications (prevention and management)
- Disease-related complications
- Patient instructions
Once guidelines are approved for the Compendium, they would be published on the Academy Education Resource Center and linked to the subspecialty Web site. They will be reviewed and/or updated on a regular basis so that they remain current and relevant to the practice of ophthalmology.
The Academy will be working with the subspecialty societies on this process. Societies will be asked to appoint a representative to work with the Academy on the compendium project. Academy staff will send a follow-up e-mail defining the process and formally asking the subspecialty societies to appoint their representatives. Initially two subspecialties will be asked to do a pilot study to test the process for developing clinical guidelines for inclusion in the Compendium. All societies will be informed about the results of the pilot study.