Clinical Practice Guidelines and Other Policy Statements

Clinical practice guidelines are important tools for improving practice. This approach, however, requires rigorous processes for guidelines development and assessment of available guidelines, as well as effective implementation of better-quality guidelines. A growing international movement is involved with assessing and improving the guidelines development process and promoting guidelines implementation. This page lists many key resources for this work, along with sources for access to guidelines relating to maternal and newborn care and health care generally.

"Online source" indicates that the resource is available online without charge. A cost-free registration may be required for access to some entries with this designation.

Access to guidelines
Systematic reviews about clinical practice guidelines
Overviews of best evidence about guidelines
Assessing and improving guidelines and guideline development programs

Access to guidelines

AAFP Clinical Recommendations, American Academy of Family Physicians

AAFP Policies on Health Issues, American Academy of Family Physicians

AAP Policy, American Academy of Pediatrics

AWHONN Position Statements, Association of Women's Health, Obstetric and Neonatal Nurses

Clinical practice guidelines, Australia National Health and Medical Research Council

Clinical practice guidelines, Society of Obstetricians and Gynaecologists of Canada

CMA Infobase: Clinical Practice Guidelines, Canadian Medical Association

College Statements, Royal Australian and New Zealand College of Obstetricians and Gynecologists

Ethical issues in obstetrics and gynecology by the FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health
[PDF]. London: International Federation of Gynecology and Obstetrics, 2009; 1-121.

Evidence-based guidelines for midwifery-led care in labour. [London:], Royal College of Midwives, [2005], 1-81.
(Online Source)

Family-centred maternity and newborn care: Public Health Agency of Canada, national guidelines, 4th edition

Guidelines, Royal College of Obstetricians and Gynaecologists

Guidelines for perinatal care, 6th ed, American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Elk Grove Village, IL: AAP, 2008.

Guideline Library, Guidelines International Network

National Guideline Clearinghouse, Agency for Healthcare Research and Quality, US Department of Health and Human Services

National Library of Guidelines: Guideline Finder, UK National Health Service

New Zealand Guidelines Group

Obstetrics, gynecology and reproductive medicine: guidelines, reviews, position statements, recommendations, standards, Geneva Foundation for Medical Education and Research

Position statements, American College of Nurse-Midwives

Position Statements, International Confederation of Midwives

Note: online access to Committee Opinions, Educational/Technical Bulletins, Guidelines for Perinatal Care and other statements of the American College of Obstetricians and Gynecologists (ACOG) is limited to ACOG's obstetrician members. Key elements of many of these statements are available in an online source, the National Guideline Clearinghouse.

Systematic reviews about clinical practice guidelines

Alonso-Coello P, Irfan A, Sola I, Gich I, Delgado-Noguera M, Rigau D, Tort S, Bonfill X, Burgers J, Schunemann H. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care. 2010;19:1-7.
(Online Source, PDF)

Chaillet N, Dubé E, Dugas M, Audibert F, Tourigny C, Fraser WD, Dumont A. Evidence-based strategies for implementing guidelines in obstetrics: a systematic review. Obstet Gynecol. 2006;108(5):1234-45.

Dijkstra R, Wensing M, Thomas R, Akkermans R, Braspenning J, Grimshaw J, Grol R. The relationship between organizational characteristics and the effects of clinical guidelines on medical performance in hospitals, a meta-analysis. BMC Health Serv Res. 2006;6(53).
(Online Source, PDF)

Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8(6):1-84.
(Online Source, PDF)

Rotter T, Kinsman L, James EL, Machotta A, Gothe H, Willis J, Snow P, Kugler J. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010, Issue 7.
(Online Source, summary)

Thomas L, Cullum N, McColl E, Rousseau N, Soutter J, Steen N. Guidelines in professions allied to medicine. Cochrane Database Syst Rev. 2009, Issue 1.
(Online Summary, summary)

Vale L, Thomas R, MacLennan G, Grimshaw J. Systematic review of economic evaluations and cost analyses of guideline dissemination and implementation strategies. European Journal of Health Economics. 2007; 8(2): 111-121.

Vlayen J, Aertgeerts B, Hannes K, Sermeus W, Ramaekers D. A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit. Int J Qual Health Care. 2005;17(3):235-42.
(Online Source, PDF)

Overviews of best evidence about guidelines

Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999;282(15):1458-65.
(Online Source)

Davis D. Getting a grip of guidelines: the science and art of implementing guidelines. Presentation at National Institute for Clinical Studies, Australia, 2004.
(Online Source, audio and slides)

Grimshaw J, Eccles M, Tetroe J. Implementing clinical guidelines: current evidence and future implications. J Contin Educ Health Prof 2004;24(supplement 1):S31-7.

Solberg LI, Brekke ML, Fazio CJ, Fowles J, Jacobsen DN, Kottke TE, Mosser G, O'Connor PJ, Ohnsorg KA, Rolnick SJ. Lessons from experienced guideline implementers: attend to many factors and use multiple strategies. Jt Comm J Qual Improv. 2000;26(4):171-88.

Assessing and improving guidelines and guideline development programs

AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care. 2003;12(1):18-23.
(Online Source)

Appraisal of Guidelines, Research, and Evaluation: AGREE

Boivin A, Currie K, Fervers B, Gracia J, James M, Marshall C, Sakala C, Sanger S, Strid J, Thomas V, van der Weijden T, Grol R, Burgers J; G-I-N PUBLIC. Patient and public involvement in clinical guidelines: international experiences and future perspectives. Qual Saf Health Care. 2010;19(5):e22.
(Online Source, PDF)

Boluyt N, Lincke CR, Offringa M. Quality of evidence-based pediatric guidelines. Pediatrics. 2005;115(5):1278-91.
(Online Source)

Bujold E. Evaluating professional society guidelines on vaginal birth after cesarean. Semin Perinatol. 2010;34(5):314-7.

Burgers JS, Cluzeau FA, Hanna SE, Hunt C, Grol R. Characteristics of high-quality guidelines: evaluation of 86 clinical guidelines developed in ten European countries and Canada. Int J Technol Assess Health Care. 2003;19(1):148-57.

Burgers JS, Grol R, Klazinga NS, Mäkelä M, Zaat J, for the AGREE Collaboration. Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual Health Care. 2003;15(1):31-45.
(Online Source)

Chauhan SP, Berghella V, Sanderson M, Magann EF, Morrison JC. American College of Obstetricians and Gynecologists practice bulletins: an overview. Am J Obstet Gynecol. 2006;194(6):1564-72.
(Online Source)

Chauhan SP, Berghella V, Sanderson M, Siddiqui D, Hendrix NW, Magann EF. Randomized clinical trials behind level A recommendations in obstetric Practice Bulletins: compliance with CONSORT statement. Am J Perinatol. 2009;26(1):445-54.

Chauhan SP, Gherman R., Hendrix NW, Bingham JM, Hayes E. Shoulder dystocia: comparison of the ACOG Practice Bulletin with another national guideline. Am J Perinatol. 2010;27(2):129-36.

Chauhan SP, Gupta LM, Hendrix NW, Berghella V, American College of Obstetricians and Gynecologists. Intrauterine growth restriction: comparison of American College of Obstetricians and Gynecologists Practice Bulletin with other national guidelines. Am J Obstet Gynecol. 2009;200(4):409e1-6.

Chauhan SP, Hendrix NW, Berghella V, Siddiqui D. Comparison of two national guidelines in obstetrics: American versus Royal College of Obstetricians and Gynecologists. Am J Perinatol. 2010;27(10):763-70.

Coomarasamy A, Ola B, Gee H, Khan KS. Quality of brief guidelines produced by professional bodies: a study of the 'green-top' guidelines by the UK Royal College of Obstetricians and Gynaecologists. J Obstet Gynaecol. 2003;23(5):479-83.

Eccles M, Mason J. How to develop cost-conscious guidelines. Health Technol Assess. 2001;5(16):1-78.
(Online Source, PDF)

Foureur M, Ryan CL, Nicholl M, Homer C. Inconsistent evidence: analysis of six national guidelines for vaginal birth after cesarean section. Birth. 2010;37(1):3-10.

Grilli R, Magrini N, Pena A, Mura G, Liberati A. Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet. 2000;355(9198):103-6.

Guidelines International Network (includes library of over 7,000 guidelines available to members)

Haertsch M, Campbell E, Sanson-Fisher R. What is recommended for healthy women during pregnancy? A comparison of seven practice guideline documents. Birth. 1999;26(1):24-30.

Holmes M. The Guidelines International Network: translating best evidence into best practice around the globe. Healthc Q. 2008:11(1):64-7, 2.

Hutchinson A, McIntosh A, Cox S, Gilbert C. Towards efficient guidelines: how to monitor guideline use in primary care. Health Technol Assess. 2003;7(18)1-110.
(Online Source, PDF)

McDonagh R, White C, Singh G, Mohide P. The quality of obstetrical clinical practice guidelines promulgated by a specialty society. J Obstet Gynaecol Can. 2002;24(12):957-62.

Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CFB, Askham J, Marteau T. Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998;2(3):1-88.
(Online Source, PDF)

Ollenschläger G, Marshall C, Qureshi S, Rosenbrand K, Burgers J, Mekela M, Slutsky J, for the Board of Trustees 2002, Guidelines International Network (G-I-N). Improving the quality of health care: using international collaboration to inform guideline programmes by founding the Guidelines International Network (G-I-N). Qual Saf Health Care. 2004;13(6):455-60.
(Online Source)

Perfetto P, Siddiqui D, Niederhauser A, Magann EF, Hill J, Chauhan SP. American College of Obstetricians and Gynecologists Practice Bulletins: original versus revised. Am J Perinatol. 2010;27(8):611-8.

Raine R, Sanderson C, Black N. Developing clinical guidelines: a challenge to current methods. BMJ. 2005;331(75117):631-3.
(Online Source)

Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed literature. JAMA. 1999;281(20):1900-5.
(Online Source)

Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J, Deshpande AM. Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization. Ann Int Med. 2003;139(6):493-8.
(Online Source)

Most recent page update: 2/4/2011

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