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Clinical Practice Guidelines: Their Use, Misuse, and Future Directions

Sanders, James O. MD; Bozic, Kevin J. MD, MBA; Glassman, Steven D. MD; Jevsevar, David S. MD, MBA; Weber, Kristy L. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: March 2014 - Volume 22 - Issue 3 - p 135–144
doi: 10.5435/JAAOS-22-03-135
Review Article
SDC

Evidence-based clinical practice guidelines (CPGs) have the potential to bring the best-quality evidence to orthopaedic surgeons and their patients. CPGs can improve quality by decreasing the variability in orthopaedic care, but they can also be misused through inappropriate development or application. The quality of a CPG is dependent on the strength of its evidence base, which is often deficient in orthopaedic publications. In addition, many surgeons express concern about legal liability associated with CPGs. Specific processes in CPG development and implementation can counter these potential problems. Other evidence tools, such as appropriate use criteria, also can help in the application of the proper treatment of patients by identifying those who are appropriate for specific procedures. Because payers, patients, and surgeons need access to the best evidence, CPGs will continue to be developed, and orthopaedic surgeons have the opportunity to ensure their proper development and implementation by understanding and participating in the process.

From the Department of Orthopaedics, University of Rochester, Rochester, NY (Dr. Sanders), the University of California, San Francisco, San Francisco, CA (Dr. Bozic), the University of Louisville, Louisville, KY (Dr. Glassman), Intermountain Healthcare, Saint George, UT (Dr. Jevsevar), and the University of Pennsylvania, Philadelphia, PA (Dr. Weber).

Dr. Sanders or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of DePuy; has stock or stock options held in Abbott, AbbVie, GE Healthcare, and Hospira; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the Pediatric Orthopaedic Society of North America, and the Scoliosis Research Society. Dr. Bozic or an immediate family member serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the American Association of Hip and Knee Surgeons, the American Joint Replacement Registry, the American Orthopaedic Association, the California Joint Replacement Registry Project, the California Orthopaedic Association, and the Orthopaedic Research and Education Foundation. Dr. Glassman or an immediate family member has received royalties from Medtronic; has received research or institutional support from NuVasive; and serves as a board member, owner, officer, or committee member of the Scoliosis Research Society. Dr. Jevsevar or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of Medacta USA; has stock or stock options held in OMNIlife science; and has received research or institutional support from Medacta USA. Dr. Weber or an immediate family member serves as a board member, owner, officer, or committee member of the Musculoskeletal Tumor Society and the Ruth Jackson Orthopaedic Society.

© 2014 by American Academy of Orthopaedic Surgeons
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