In September 2011, APA adopted a new development process intended to meet standards of the Institute of Medicine, now known as the National Academy of Medicine, published in March 2011, including establishing transparency, managing conflicts of interest, composing work groups, using systematic reviews of evidence, articulating and rating recommendations in guidelines, obtaining external review, and updating.
Some of the key changes made to the guideline development process to make it more transparent and rigorous are:
- Guidelines are organized around clinical questions, which may be in PICO(TS) format, i.e., population, intervention, comparison, outcome and when applicable, timing and setting.
- Subject matter experts from multiple disciplines and patient/family advocates provide input.
- Guideline statements are separately rated according to strength of supporting research evidence and strength of recommendation.
- Strength of supporting research evidence is determined through systematic review of the evidence, determinations of the risk of bias of individual studies, and assessment of the overall quality of the body of research evidence.
- In the absence of high quality research evidence, APA has chosen to use expert opinion as determined by formal survey of large panels of research and clinical experts.
- Consensus about guideline statements and ratings is determined by modified Delphi method through blind iterative voting.
- Guidelines are published as sets of recommendations or suggestions, each addressing a clinical question or related set of clinical questions.
- Literature searches are conducted on a regular basis after guideline publication with updating of guideline statements and text, as needed, to maintain all guidelines as current.