Keeping Preferred Practice Pattern® Guidelines Current
Preferred Practice Patterns (PPPs) are on a scheduled major revision timetable of every 5 years. This revision includes the entire PPP—Background and Care Process.
The procedure used to ensure that recommendations for care in the PPPs are current throughout the 5-year period between major revisions follows. This process involves identifying new evidence and assessing whether the evidence warrants an update. The process used to undertake interim revisions (between the major 5-year revision) is described.
Methods of Identifying New Evidence
Hoskins Center staff (Director of Quality of Care and Knowledge Base Development, Manager of Guidelines and Assessments, Clinical Information Services Specialist) scan the following clinical journals, newsletters, and online sources to identify new evidence:
- American College of Surgeons Bulletin
- American Journal of Ophthalmology
- American Medical Association News
- Archives of Ophthalmology
- British Journal of Ophthalmology
- Cochrane Library
- Evidence-Based Eye Care
- Eye and Contact Lens
- Health Affairs
- International J of Technology Assessment in Health Care
- Investigative Ophthalmology and Visual Science
- J of Am Assoc for Pediatric Ophthamology and Strabismus
- Journal of the American Medical Association
- Journal of the American Society of Ophthalmic Plastic and Reconstructive Surgery
- Journal of Cataract and Refractive Surgery
- Journal or Glaucoma
- Journal of Neuro-Ophthalmology
- Journal of Pediatric Ophthalmol & Strabismus
- Journal of Refractive Surgery
- Medical Economics
- New England Journal of Medicine
- Ocular Surgery News
- Ophthalmic Epidemiology
- Ophthalmic Surgery, Lasers and Imaging
- Review of Ophthalmology
- Survey of Ophthalmology
- Chairs and/or members of PPP panels notify staff of new evidence
- Investigators conducting research notify Academy staff or Academy committee members of upcoming evidence
- Each year, panel chairs are asked to answer the following question1 for their respective PPPs.
Are you aware of new evidence or developments in the field relevant to the recommendations for care in the PPP?
Assessing Whether The Evidence Warrants An Update
At the Panel chair discretion, PPP panel members discuss new evidence by e-mail or telephone conference call and decide whether evidence warrants an interim revision to the PPP. Questions to answer are:
- Is the new evidence or development of sufficient importance to invalidate the recommendations for care in the PPP?
- Are there new recommendations for care that should be present?
The panel chair reports at the annual Spring PPP committee meeting whether there are changes to practice patterns that would alter the evidence-based recommendations for care or require additional recommendations for care. The final decision for undertaking interim revisions rests with the PPP committee
Process for Interim Revisions
- Panels work primarily by e-mail with conference calls as necessary
- Panel members identify one author or share assignments to create a first draft of the update
- A limited wide review is undertaken (timelines may be very short)
- PPP is published with "Limited Revision" added to the title
- Five year revision schedule does not change because of the interim revision
- Panel members receive one achievement award point for their work on the interim revision (necessary because the PPP panel is not actively engaged in a scheduled 5-year update)
Examples of PPPs with Limited Revision
- The recommendations for care in the Age-Related Macular Degeneration PPP were changed because of the availability of newer treatments; limited revisions were published in September 2005 and September 2006.
Rationale For Process1
- Conducting a yearly systematic review of the literature to identify new evidence for updating PPPs would be too costly
- Evidence sufficient to warrant updates to a PPP would be known to experts in the field or would have been published in major medical journals
1. Shekelle PG, Ortiz E, Rhodes S, et al. Validity of the Agency for Healthcare Research and Quality clinical practice guidelines. How quickly do guidelines become outdated? JAMA 2001; 286:1461-7.