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Clinical Practice Guidelines We Can Trust (2011)

Chapter: Appendix F: Committee Biographies

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Suggested Citation:"Appendix F: Committee Biographies." Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. doi: 10.17226/13058.
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Appendix F
Committee Biographies

Sheldon Greenfield, M.D. (Chair), an internationally recognized leader in quality of care and health services research, is the Donald Bren Professor of Medicine and Executive Codirector of the Health Policy Research Institute at the University of California–Irvine. Dr. Greenfield’s research has focused on primary care outcomes, quality of chronic disease care, patient participation in care, and assessment of comorbidity. He was the 1995 recipient of the PEW Health Professions Commission Award for lifetime achievement in Primary Care Research. Dr. Greenfield is a recipient of the Glaser Award of the Society of General Internal Medicine and the 1999 Novartis Global Outcomes Leadership Award. Dr. Greenfield is the 2006 recipient of the Founders Award by the American College of Medical Quality. Dr Greenfield was elected to the Institute of Medicine (IOM) in 1996. He chaired the IOM Committee on Guidance for Designing a National Health Care Disparities Report, and chaired the IOM cancer survivorship report. He was chair of the National Diabetes Quality Improvement Alliance. He was also cochair of the IOM Committee on Initial National Priorities for Comparative Effectiveness Research. His current research focus is on performance assessment at the individual physician level, heterogeneity of treatment effects, and quality of chronic disease care for ethnic and racial minorities. He received his undergraduate degree from Harvard College and his M.D. from the University of Cincinnati College of Medicine.

Suggested Citation:"Appendix F: Committee Biographies." Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. doi: 10.17226/13058.
×

Earl P. Steinberg, M.D., M.P.P. (Vice Chair), is senior vice president for Integrated Health Strategy and Evaluation at WellPoint, Inc., and president and chief executive officer CEO of Resolution Health, Inc., a wholly owned subsidiary of WellPoint Inc. He is a nationally recognized expert in evaluation and improvement of the quality and efficiency of health care. He has had considerable experience in development of evidence-based clinical practice guidelines and of performance measures based on them, as well as with interventions to increase compliance with them. At the IOM, Dr. Steinberg served on the Committee on Medicare Payment Methodology for Clinical Laboratory Services and the Evaluation Panel of the Council on Health Care Technology. Prior to joining Resolution Health, Dr. Steinberg was vice president of Covance Health Economics and Outcomes Services, Inc., where he was also codirector of the Outcomes Studies Group and director of the Quality Assessment and Improvement Systems Division. Dr. Steinberg spent 12 years as a full-time faculty member at Johns Hopkins University, where he was a professor of medicine, a professor of health policy and management, and the founder and director of the Johns Hopkins Program for Medical Technology and Practice Assessment. Dr. Steinberg has spent many years on the Blue Cross Blue Shield Association’s National Medical Advisory Panel. Dr. Steinberg received his A.B. from Harvard College, his M.D. from Harvard Medical School, and his M.P.P. from the Kennedy School of Government at Harvard. He performed his residency training in internal medicine at the Massachusetts General Hospital.


Andrew Auerbach, M.D., M.P.H., is associate professor of medicine in residence at the University of California–San Francisco (UCSF) and a clinician–researcher in the Division of Hospital Medicine. He joined the faculty at UCSF as the nation’s first hospitalist clinician–researcher in 1998. Dr. Auerbach retains an active clinical practice as a hospitalist—both as a ward attending and as an attending on the medical consultation service. In addition to leading clinical practice standardization and order-entry projects at UCSF, his research there has focused primarily on assessments of patient outcomes in different systems of care, with a special interest in the hospitalist model. Additionally he has concentrated on novel approaches to clinical practice translation through enhanced performance measurement. He did his medical residency training at Yale-New Haven Hospital, and a Fellowship in General Internal Medicine at Harvard and Beth Israel Deaconess Medical Center.


Jerome Avorn, M.D., is a professor of medicine at Harvard Medical School and chief of the Division of Pharmacoepidemiology and

Suggested Citation:"Appendix F: Committee Biographies." Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. doi: 10.17226/13058.
×

Pharmacoeconomics at Brigham and Women’s Hospital. Previously, Dr. Avorn was a member of the IOM Committee on Health Promotion and Disability Prevention for the “Second Fifty.” An internist, geriatrician, and pharmacoepidemiologist, his research centers on medication use, with particular reference to elderly patients and chronic disease. Topics of particular interest include drug approval; transparency; scientific, policy, and social determinants of physician prescribing practices; efficacy and effectiveness of specific medications; compliance by patients with prescribed regimens; methods to improve the appropriateness of drug prescribing and drug taking; quantification of risks and benefits of drugs; and pharmaceutical cost-effectiveness analysis. The research unit Dr. Avorn founded includes faculty representing the disciplines of epidemiology, internal medicine, health services research and policy, social science, and biostatistics. Dr. Avorn has served on several national and international panels as an expert on the determinants and outcomes of medication use. He is a past president of the International Society for Pharmaco-Epidemiology. He is author or coauthor of more than 250 papers in the medical literature on medication use and its outcomes and of the book, Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs (Knopf, 2004), now in its 11th printing. He attended Columbia College and Harvard Medical School, and completed a residency in Internal Medicine at the Beth Israel Hospital in Boston.


Robert S. Galvin, M.D., M.B.A., is chief executive officer of Equity Healthcare (EH), which oversees the management of health care for firms owned by private equity companies. The focus is on using purchasing power to create innovative ways to achieve higher value in health care through improved population health, clinical quality, and delivery system reforms. EH encompasses more than 30 companies with healthcare spending exceeding $2 billion annually. Before joining Blackstone, Dr. Galvin was executive director of health services and chief medical officer for General Electric (GE) for 15 years. At GE he was in charge of the design and the financial and clinical performance of GE’s health programs. He was also responsible for health policy strategies affecting employees. Dr. Galvin is a nationally recognized leader in the areas of market-based health policy and financing, quality measurement, and payment reform. His work has been widely published in the New England Journal of Medicine and Health Affairs. He was a cofounder of the Leapfrog Group and founder of Bridges to Excellence, two innovative nonprofits that have helped drive the quality agenda. Dr. Galvin is on the IOM Board on Health Care Services

Suggested Citation:"Appendix F: Committee Biographies." Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. doi: 10.17226/13058.
×

and has served on numerous IOM committees. He is on the Board of Directors of the National Quality Forum. He is a member of the National Advisory Council for the Agency for Healthcare Research and Quality (AHRQ) and is a former member of the Defense Health Board. Dr. Galvin is also an adjunct professor of medicine and health policy at Yale. His work has received awards from the National Business Group on Health, the Healthcare Financial Management Association, and the National Coalition for Cancer Survivorship. He is a fellow of the American College of Physicians.


Raymond Gibbons, M.D., is the Arthur M. and Gladys D. Gray Professor of Medicine at the Mayo Clinic. Dr. Gibbons’ research interests include coronary disease, myocardial infarct quantitation, and cardiac imaging. He was president of the American Heart Association (AHA) from 2006 to 2007. He served previously as chair of the American College of Cardiology/AHA Task Force on Practice Guidelines, chair of two ACC/AHA guideline writing committees (stable angina and exercise testing), and chair of the Committee on Scientific Sessions of the AHA. After graduate work in Mathematics at Oxford and Biomedical Engineering at the Johns Hopkins University, he completed his M.D. at Harvard Medical School, where he was a member of the Harvard–Massachusetts Institute of Technology (MIT) Program in Health Sciences and Technology. He then completed a residency in Internal Medicine at Massachusetts General Hospital and a Cardiology Fellowship at Duke University Medical Center.


Joseph Lau, M.D., is professor of medicine, professor of clinical and translational science (Sackler School for Graduate Biomedical Sciences), and adjunct professor (Friedman School for Nutrition Sciences and Policy) at Tufts University. He directs the Tufts Evidence-based Practice Center (EPC), one of 14 AHRQ-designated evidence-based practice centers. Dr. Lau also directed the Boston Branch of the U.S. Cochrane Center (1996–2007) and the evidence review team of the National Kidney Foundation’s clinical practice guidelines program (2000–2009). He has published more than 200 journal articles and book chapters on applications and methodologies of systematic review and meta-analysis, along with more than 50 evidence reports and technology assessments. He has served on a Food and Drug Administration advisory panel, an IOM committee (Framework for Evaluating the Safety of Dietary Supplements), and as a drafting expert on an FAO/WHO workgroup. He is on the editorial boards of the European Journal of Clinical Investigation, Journal

Suggested Citation:"Appendix F: Committee Biographies." Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. doi: 10.17226/13058.
×

of Research Synthesis Methods, Journal of Nutrition, and BMC Medical Research Methodology. He is a member of the Association of American Physicians. Dr. Lau received his M.D. from the Tufts University School of Medicine.


Monica Morrow, M.D., is chief of the Breast Service in the Department of Surgery and the Anne Burnett Windfohr Chair of Clinical Oncology at Memorial Sloan-Kettering Cancer Center and a professor of surgery at Weill Medical College of Cornell University. At the IOM, she was a member of the Committee on Cancer Survivorship: Improving Care and Quality of Life After Treatment, the National Cancer Policy Board, and the Committee to Conduct a Workshop on the Development of a Research Agenda Concerning Medical Diagnosis and Treatment of Breast Cancer. Her current research interest is focused on how treatment choices for breast cancer surgery are made. She is the surgical editor of the textbook Diseases of the Breast and a coauthor of Breast Cancer for Dummies. Dr. Morrow cochaired the joint committee of the American College of Surgeons, American College of Radiology, and College of American Pathologists on Standards for Breast Conserving Therapy for Invasive Breast Cancer and for Ductal Carcinoma In Situ in 2002 and 2007. She is currently serving as secretary of the Society for Surgical Oncology. She received her M.D. from Jefferson Medical College in Philadelphia.


Cynthia Mulrow, M.D., M.Sc., is clinical professor of medicine at the University of Texas Health Science Center at San Antonio and the senior deputy editor of the Annals of Internal Medicine. She was previously director of the San Antonio VA Cochrane Center, program director of the Robert Wood Johnson Foundation’s Generalists Physician Scholars Program, and director of the San Antonio Evidence-based Practice Center. Dr. Mulrow has served on the editorial boards of the British Medical Journal, American Journal of Medicine, ACP Journal Club, and Clinical Evidence-based Therapeutics Compendium. She is a member of the IOM and serves on the IOM Board on Health Care Services. She was a member of the IOM Subcommittee on the Health Outcomes of the Uninsured. She was also a member of the U.S. Preventive Services Task Force and has served on guideline development panels for RAND and AHRQ. Dr. Mulrow’s expertise is in clinical methodology, information synthesis, systematic reviews, and clinical guidelines. She participates in multiple groups that develop reporting standards for medical research, including CONSORT (reporting standards for trials), PRISMA (reporting standards for systematic reviews), and STROBE (reporting standards for observational studies).

Suggested Citation:"Appendix F: Committee Biographies." Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. doi: 10.17226/13058.
×

Arnold J. Rosoff, J.D., is a professor of legal studies and business ethics and a professor of healthcare management at the Wharton School of the University of Pennsylvania (Penn) as well as a Senior Fellow at Penn’s Leonard Davis Institute of Health Economics. His research and writing have covered a diverse range of subjects in health law and policy, including legal, regulatory, and business aspects of health care; legal implications of evidence-based medicine (i.e., the law’s recognition and treatment of clinical practice guidelines, or CPGs); ethical issues in public health practice; legal and regulatory controls on healthcare cost and quality; patients’ rights, especially “informed consent” issues; pharmacy benefits management; private and governmental financing of health care, including health maintenance organizations; antitrust issues in health care; and comparative healthcare systems. His recent research has focused on U.S. attempts to achieve universal health care (UHC); analysis of GINA, the Genetic Information Non-Discrimination Act of 2008; implications of consumer-driven health care; and applications of information technology to healthcare delivery and financing. He is currently writing a comparative study of the path that five nations—Argentina, France, Italy, Japan, and Singapore—took to reach their national commitment to UHC, analyzing how their experiences may be useful to U.S. efforts to achieve UHC. Professor Rosoff’s most direct connection with this committee’s subject matter is the research and writing he has done on the promotion of evidence-based medicine and its implementation through CPGs and computerized clinical decision support systems. Professor Rosoff has an undergraduate degree in Economics from Penn and a J.D. from Columbia University.


John Santa, M.D., M.P.H., is director of the Consumer Reports Health Ratings Center. The Center provides unbiased analyses and ratings to help consumers make informed healthcare decisions. Objective, up-to-date comparisons of health services, drugs, devices, and consumer experiences from credible internal and external testing sources are used. Dr. Santa was the administrator of the Office of Oregon Health Policy and Research from 2000 to 2003, focusing on evidence-based approaches to treatments and prescription drugs. He previously worked in medical leadership positions for hospitals, physician groups, and health insurers. In each position he focused on clinical guidelines, quality improvement, and performance. Dr. Santa has taught in multiple environments, including medical school, residency training, and graduate courses, most recently serving as an associate professor at Oregon Health & Science University and

Suggested Citation:"Appendix F: Committee Biographies." Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. doi: 10.17226/13058.
×

Portland State University. He has practiced primary care internal medicine in solo, group, and institutional settings, most recently at the Portland VA.


Richard Shiffman, M.D., MCIS, is professor of pediatrics and associate director of the Center for Medical Informatics at Yale School of Medicine. He is a Fellow of the American College of Medical Informatics and the American Academy of Pediatrics. Dr. Shiffman has served on several guideline development panels for national professional societies and on the American Academy of Pediatrics Steering Committee on Quality Improvement and Management. He was also a member of the Board of the Guidelines International Network. Dr. Shiffman convened the Conference on Guideline Standardization in 2002 and leads the group that developed the Guideline Elements Model, a standard for electronic representation of guideline documents. Currently, he leads the GLIDES Project, an AHRQ-sponsored initiative to define best practices for transforming guidelines into clinical decision support. Dr. Shiffman served his pediatric residency at Children’s Hospital of Philadelphia and the Riley Children’s Hospital in Indianapolis. He was Chief Resident in Pediatrics at the University of Colorado Medical Center and completed a Fellowship there in Developmental Pediatrics. Dr. Shiffman practiced primary care pediatrics in Colorado for 12 years. He earned a Master’s in Computer Information Systems from the University of Denver. He completed a Fellowship in Medical Informatics in the Harvard–MIT program before joining the faculty at Yale.


Wally Renee Smith, M.D., is a general internist, professor of internal medicine, and chair of the Division of Quality Health Care at Virginia Commonwealth University (VCU). He is also scientific director of the VCU Center on Health Disparities and vice president of the Foundation for Integrity and Responsibility in Medicine. Dr. Smith was an inaugural Robert Wood Johnson Generalist Physician Faculty Scholar. He has been on the editorial boards of the journals Medical Decision Making and the Journal of Continuing Education in the Health Professions. He is past North American editor of Clinical Governance, an international journal, and past deputy editor of the Journal of General Internal Medicine. He has served on study sections or expert leadership panels for the National Institutes of Health (NIH), AHRQ, National Library of Medicine, Veterans Administration Health Services Research and Development Program, and the Health Resources and Services Administration. He is past secretary of the Society of General Internal Medicine and past Trustee for

Suggested Citation:"Appendix F: Committee Biographies." Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. doi: 10.17226/13058.
×

the Society for Medical Decision Making. He has authored more than 70 peer-reviewed publications and 40 externally funded grants or contracts. He is an expert in disparities issues in clinical and health services, clinical epidemiology, and medical decision making.


Walter F. Stewart, Ph.D., M.P.H., is associate chief research officer for the Geisinger Health System and director of the Center for Health Research. The Center has a strong focus on health services research and the use of information technology in reengineering care processes, as well as other areas of emphasis, including comparative effectiveness studies, population-level validation of biomarkers for clinical decision making, and formalizing system-level processes for translating research to practice. Prior to taking his position at Geisinger in 2003, Dr. Stewart started IMR, a privately held clinical trials and survey research company. The company developed novel approaches to population-based clinical trials that accelerated Phase III time lines. IMR was acquired in 1998 by AdvancePCS, where Dr. Stewart was vice president of Research and Development and director of the Center for Work and Health from 1998 to 2002. The latter focused on employer direct and indirect costs from illness and development of tools to measure lost productivity. Between 1983 and 1995, Dr. Stewart was a full-time faculty member of the Johns Hopkins Bloomberg School of Public Health, where he maintains an adjunct professor position. Since his tenure at Hopkins, Dr. Stewart has studied the epidemiology of common chronic episodic conditions (e.g., migraine, bladder control, gastrointestinal disorders), the work impact of these conditions, and the progressive central nervous system disorders. He has authored more than 240 journal articles and book chapters on these and other subjects. Dr. Stewart earned his Ph.D. in Epidemiology from Johns Hopkins University, an M.P.H. from the University of California–Los Angeles, and a Bachelor’s Degree in Psychobiology from the University of California–Riverside.


Ellen Stovall is a 39-year survivor of three diagnoses of cancer. Following 18 years as CEO of the National Coalition for Cancer Survivorship (NCCS), she stepped down from that position and currently serves as the NCCS senior health policy advisor. Ms. Stovall has served on a number of IOM committees and was vice chair of the IOM’s National Cancer Policy Board as well as vice chair of its Committee on Cancer Survivorship. In that role, Ms. Stovall coedited the IOM report titled From Cancer Patient to Cancer Survivor: Lost in Transition. She was also a member of the IOM National Cancer Policy

Suggested Citation:"Appendix F: Committee Biographies." Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. doi: 10.17226/13058.
×

Forum. In addition, Ms. Stovall served as vice chair of the Robert Wood Johnson Foundation’s National Advisory Committee for Pursuing Perfection: Raising the Bar for Health Care Performance. She also served on the Board of Directors of the National Committee for Quality Assurance and the Leapfrog Group. In an appointment she received from President Bill Clinton, Ms. Stovall was a member of the National Cancer Institute’s National Cancer Advisory Board, an appointment she received from President Bill Clinton. Ms. Stovall is a founder and, along with Dr. Patricia Ganz, cochairs the Cancer Quality Alliance (CQA)—an alliance formed in 2005 to promote collaboration among stakeholders who are committed to cancer quality improvement. CQA activities include fostering the rapid development and implementation of measures appropriate for quality improvement and accountability; enhancing mechanisms for data collection; promoting development and adoption of oncology electronic medical records; and endorsing a blueprint for optimal cancer care. Recognizing a need for the voice of cancer survivors to be heard during the national debate over healthcare reform, the Cancer Leadership Council was convened in 1993 under her direction. Ms. Stovall currently serves as cochair with Dr. George Isham of the National Quality Forum’s Measures Prioritization Committee, and is a member of the IOM Committee on Standards for Developing Trustworthy Clinical Practice Guidelines.


Brian L. Strom, M.D., M.P.H., holds numerous leadership positions at the University of Pennsylvania. He is George S. Pepper Professor of Public Health and Preventive Medicine, founding chair and professor of biostatistics & epidemiology, professor of medicine, professor of pharmacology, founding director of the Center for Clinical Epidemiology & Biostatistics, founding director of the Graduate Group in Epidemiology & Biostatistics, vice dean for Institutional Affairs School of Medicine, and senior advisor to the Provost for Global Health Initiatives. He is a member of the IOM and chair of the IOM Committee to Assess the Safety and Efficacy of the Anthrax Vaccine and the Committee on the Smallpox Vaccination Program Implementation, He is also a member of the Committee to Review the CDC (Centers for Disease Control and Prevention) Anthrax Vaccine Safety and Efficacy Research Program and the Committee to Review the NIOSH (National Institute for Institutional Safety and Health) Traumatic Injury Research Program. Internationally known for multiple areas of clinical epidemiology, Dr. Strom’s major career interest is pharmacoepidemiology, specifically looking at adverse drug reactions and medical errors. He is editor of the field’s major

Suggested Citation:"Appendix F: Committee Biographies." Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. doi: 10.17226/13058.
×

text (now going into its fifth edition), was president of the International Society of Pharmacoepidemiology (ISPE), and is now editor in chief for Pharmacoepidemiology and Drug Safety, ISPE’s official journal. He received his M.D. from Johns Hopkins University School of Medicine and his M.P.H. from the University of California–Berkeley.


Marita G. Titler, Ph.D., R.N., FAAN, is a professor and associate dean of Clinical Scholarship & Practice Development and the Rhetaugh G. Dumas Endowed Chair at the University of Michigan School of Nursing. At the IOM, she was a member of the Forum on the Science of Health Care Quality Improvement and Implementation. Her experience includes serving as director of the Translation Core of the $2.34 million federally funded Gerontological Nursing Interventions Research Center and the Institute of Translational Practice on the $3.49 million Department of Veterans Affairs Center of Excellence and the Implementation of Innovative Strategies in Practice (CRIISP) at the University of Iowa. She served as Principal Investigator and completed a $1.5 million AHRQ grant on Evidence-Based Practice: From Book to Bedside, competing continuation From Book to Bedside: Promoting and Sustaining EBPs in the Elders, a $1.3 million NINR grant on Nursing Interventions & Outcomes in 3 Older Populations, and the Robert Wood Johnson Foundation INQRI grant on Impact of System-Centered Factors, and Processes of Nursing Care on Fall Prevalence and Injuries from Falls. She is currently Principal Investigator on the Robert Wood Johnson Foundation INQRI grant Moving Beyond Fall Risk Scores: Implementing and Evaluating the Impact of an Evidence-Based “Targeted Risk Factor Fall Prevention Bundle”; Co-Principal Investigator on the $2.8 million National Cancer Institute Grant on Cancer Pain in Elders: Promoting EBPs in Hospices; Investigator on AHRQ R03, Call Light Responsiveness and Effect on Inpatient Falls and Patient Satisfaction; Co-Investigator on an NIH R41 Advancing Patient Call Light Systems to Achieve Better Outcomes; Co-Investigator on a Department of Health and Human Services, NIH U01, Dissemination of Tobacco Tactics versus 1-800-QUIT-NOW for Hospitalized Smokers; Co-Investigator on the Department of Defense grant Assessing the Effect of a Handheld Decision-Support Device for Reducing Medication Errors; and Co-Investigator on the University of Michigan Clinical and Translational Science Award for the Michigan Institute of Clinical and Health Research.

Suggested Citation:"Appendix F: Committee Biographies." Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. doi: 10.17226/13058.
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Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes.

Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review—guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating.

Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.

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