J. Dik F. Habbema, PhD; Timothy J. Wilt, MD, MPH; Ruth Etzioni, PhD; Heidi D. Nelson, MD, MPH; Clyde B. Schechter, MD, MA; William F. Lawrence, MD, MS; Joy Melnikow, MD, MPH; Karen M. Kuntz, ScD; Douglas K. Owens, MD, MS; Eric J. Feuer, PhD
Disclaimer: This paper reflects the opinions of the authors only and not of guideline development groups in which they are involved; organizations with which they are affiliated; or the Agency for Healthcare Research and Quality, the National Cancer Institute, the U.S. Department of Health and Human Services, or the U.S. Department of Veterans Affairs.
Acknowledgment: The authors thank Therese Miller for her valuable comments.
Financial Support: Dr. Wilt is supported by grants from the U.S. Department of Veterans Affairs and the Agency for Healthcare Research and Quality and contracts to conduct evidence synthesis from the American College of Physicians, the National Kidney Foundation, and Kidney Diseases International. Dr. Nelson is supported by the Agency for Healthcare Research and Quality and the National Institutes of Health. Dr. Schechter is supported by grants from the National Cancer Institute to develop and apply models of breast cancer epidemiology. Dr. Melnikow receives extramural support from the California Health Benefits Review Program and the National Institutes of Health. Dr. Owens is supported by the U.S. Department of Veterans Affairs.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0845.
Corresponding Author: J. Dik F. Habbema, PhD, Department of Public Health, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Habbema: Department of Public Health, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
Dr. Wilt: Minneapolis VA Center for Chronic Disease Outcomes Research and the University of Minnesota School of Medicine, 1 Veterans Drive (111-0), Minneapolis, MN 55417.
Dr. Etzioni: Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M2-B230, PO Box 19024, Seattle, WA 98109-1024.
Dr. Nelson: Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Mailcode BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
Dr. Schechter: Department of Family & Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461.
Dr. Lawrence: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850.
Dr. Melnikow: Center for Healthcare Policy and Research, University of California, Davis, 4860 Y Street, Sacramento, CA 95817.
Dr. Kuntz: School of Public Health, University of Minnesota, 420 Delaware Street SE, D360, Mayo MMC 729, Minneapolis, MN 55455.
Dr. Owens: Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, 117 Encina Commons, Stanford, CA 94305.
Dr. Feuer: Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892.
Author Contributions: Conception and design: J.D.F. Habbema, R. Etzioni, H.D. Nelson, W.F. Lawrence, J. Melnikow, K.M. Kuntz, D.K. Owens, E.J. Feuer.
Analysis and interpretation of the data: J.D.F. Habbema, T.J. Wilt, R. Etzioni, C.B. Schechter, J. Melnikow, K.M. Kuntz, D.K. Owens, E.J. Feuer.
Drafting of the article: J.D.F. Habbema, T.J. Wilt, R. Etzioni, H.D. Nelson, C.B. Schechter, J. Melnikow, D.K. Owens, E.J. Feuer.
Critical revision of the article for important intellectual content: J.D.F. Habbema, T.J. Wilt, R. Etzioni, H.D. Nelson, C.B. Schechter, W.F. Lawrence, J. Melnikow, K.M. Kuntz, D.K. Owens, E.J. Feuer.
Final approval of the article: J.D.F. Habbema, R. Etzioni, H.D. Nelson, C.B. Schechter, W.F. Lawrence, J. Melnikow, K.M. Kuntz, D.K. Owens, E.J. Feuer.
Provision of study materials or patients: C.B. Schechter.
Statistical expertise: R. Etzioni, C.B. Schechter, K.M. Kuntz.
Administrative, technical, or logistic support: E.J. Feuer.
Collection and assembly of data: J.D.F. Habbema, R. Etzioni.
Clinical practice guidelines should be based on the best scientific evidence derived from systematic reviews of primary research. However, these studies often do not provide evidence needed by guideline development groups to evaluate the tradeoffs between benefits and harms. In this article, the authors identify 4 areas where models can bridge the gaps between published evidence and the information needed for guideline development applying new or updated information on disease risk, diagnostic test properties, and treatment efficacy; exploring a more complete array of alternative intervention strategies; assessing benefits and harms over a lifetime horizon; and projecting outcomes for the conditions for which the guideline is intended. The use of modeling as an approach to bridge these gaps (provided that the models are high-quality and adequately validated) is considered. Colorectal and breast cancer screening are used as examples to show the utility of models for these purposes. The authors propose that a modeling study is most useful when strong primary evidence is available to inform the model but critical gaps remain between the evidence and the questions that the guideline group must address. In these cases, model results have a place alongside the findings of systematic reviews to inform health care practice and policy.
J. Dik F. Habbema, Timothy J. Wilt, Ruth Etzioni, Heidi D. Nelson, Clyde B. Schechter, William F. Lawrence, et al. Models in the Development of Clinical Practice Guidelines. Ann Intern Med. 2014;161:812–818. doi: 10.7326/M14-0845
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Published: Ann Intern Med. 2014;161(11):812-818.
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