Where else to go for Clinical Guidelines (Now that Guideline.gov won’t be maintained)

Background: Over the weekend, a bunch of #MedTwitter and others started rightfully freaking out about the following notice on www.guideline.gov

While we all share some angst that AHRQ will no longer be supporting the National Guideline Clearinghouse, and that all of this is happening in a political climate that isn’t exactly supportive of scientific evidence, there are fortunately a number of ways to continue to find and use clinical practice guidelines.

As a stopgap measure until this site goes back up, or until the database can be migrated to live elsewhere, I’ll give you some resources that may help.

(It should go without saying I hope that someone else will pick up this database, and perhaps be able to maintain it more actively, including information such as bias score for each guideline using the AGREE II tool, categorizing guidelines that are for specific country or resource setting contexts, and clearly showing which guidelines are most recent and which are out-of-date, but that should be an organization well-suited to do so with plenty of expertise in evidence based medicine. As an example of maintenance, some of the “new this week” NGC listings in July 2018 were guidelines published in December 2017 or earlier.)

Important to note: The US Government isn’t in the business of developing or publishing clinical guidelines except as part of some specific initiatives, and no guidelines are actually going away with this website closing. The NGC serves mostly as a card catalog, or link library, for existing guideline efforts, and while it aims to be comprehensive, it’s not the first place that most practicing clinicians go to access guidelines, because they go to their specialty societies, apps, or EHR (electronic health record) resources.

Other Repositories and Libraries with Guidelines

The International Guideline Library is maintained by the Guidelines International Network (GIN). However, it does include many guidelines that are old (>2 years without update) and is missing some key US references such as those from the National Comprehensive Cancer Network.

While not guidelines per se, the Cochrane Library contains a vast database of systematic reviews that in many cases may be more up to date than published guidelines efforts, particularly around specific clinical issues.

The CPG Infobase is the Canadian repository for guidelines. While Canada-specific, the AHRQ database included all countries.

Evidence Search is maintained by the National Health Service of the UK and is another great reference, although mostly relevant to the United Kingdom.

For those who want an app for that, check out GuidelineCentral.com, which plugs in to a lot of the professional society guidelines listed below, and lets you get them on your mobile device.

Finding Guidelines on PubMed

One of the biggest drawbacks of any repository, including NGC and GIN’s library, is that they often lag significantly behind the publication of new guidelines, or in some cases are missing important ones. In this case, PubMed is your friend, and searching it for recently published guidelines is easy to do.

PubMed.com has a search filter that you can limit by publication type so that only guidelines show up. Choose Advanced Search, select “Publication Type” in the drop-down menu, and then type in “Guideline” or “Clinical Guideline” or “Practice Guideline” to filter down your results.

The advanced search by Publication Type function on PubMed.com

Go Directly to the Guidelines-Writing Organizations

As a note, I have not vetted any of these guidelines against AGREE II or other criteria, but you can often find those assessments on PubMed as well. These are all recognized professional societies and have explanations of their guideline-generating methodology and approach.

Allergy:

American College of Allergy, Asthma and Immunology (ACAAI) and American Academy of Allergy, Asthma and Immunology (AAAAI) Joint Task Force on Practice Parameters

Anesthesiology:

American Society of Anesthesiologists Guidelines

Cancer/Oncology:

National Comprehensive Cancer Network: Clinical Practice Guidelines in Oncology

American Society for Clinical Oncology: ASCO Guidelines

Cardiology:

American College of Cardiology Guidelines

Dermatology:

American Academy of Dermatology Guidelines

Emergency Medicine:

The American College of Emergency Physicians states that clinical practice guidelines do not represent the standard of care for emergency medicine. They do have a set of Clinical Policies available for reference.

Endocrinology:

American Association of Clinical Endocrinologists Guidelines

Endocrine Society Guidelines

Gastroenterology:

American College of Gastroenterology Guideline

General Medicine/Internal Medicine:

American College of Physicians Guidelines

Genetics and Genomics:

American College of Medical Genetics and Genomics Guidelines

Infectious Disease:

Infectious Diseases Society of America Guidelines

Nephrology:

International Society of Nephrology Guidelines

National Kidney Foundation Guidelines

Neurology:

American Academy of Neurology Guidelines

Obstetrics/Gynecology:

American College of Obstetricians and Gynecologists Guidelines

Occupational Therapy:

American Occupational Therapy Association Guidelines

Ophthalmology:

American Academy of Ophthalmology: Guidelines Search Tool

Otolaryngology/Ear Nose Throat/Head and Neck Surgery:

American Academy of Otolaryngology Guidelines

Orthopedic Surgery/Sports Medicine:

American Academy of Orthopaedic Surgeons Guidelines

Palliative Care and Hospice:

National Hospice and Palliative Care Organization: Standards

Pediatrics:

Not guidelines, but American Academy of Pediatrics maintains a wealth of resources and clinical tools including algorithms and calculators.

Physical Therapy:

American Physical Therapy Association Guidelines

Psychiatry:

American Psychiatric Association Guidelines

Pulmonary Disease:

American Thoracic Society Guidelines

Radiology:

American College of Radiology Practice Parameters and Technical Standards

Rheumatology:

American College of Rheumatology: Clinical Practice Guidelines

Surgery:

Society for Vascular Surgery Guidelines

American Society of Colon and Rectal Surgeons Guidelines

Society of Surgical Oncology Guidelines

Urology:

American Urological Association Guidelines

Places to Learn More About Clinical Guidelines

National Institutes of Health: About Systematic Evidence Reviews and Clinical Practice Guidelines

Open Clinical: Knowledge Management for Clinical Care

Why I Spent My Saturday Night Doing This

Many reasons: I’m a cancer survivor, a doctorate student in Evidence Based Health Care at the University of Oxford Centre for Evidence Based Medicine, a consultant in the health care industry, an alumna of National Comprehensive Cancer Network where I learned the importance of clinical practice guidelines, and someone who loves medical science and the people who devote their lives to its advancement.

Did I miss any guidelines references that should be listed? Let me know by commenting here or emailing jennifer.hinkel @ kellogg.ox.ac.uk