Evidence To Practice

Clinical Practice Guidelines DB

State of Development

In the domestic medical community, organizations such as the National Evidence-based Healthcare Collaborating Agency (NECA) and the Korean Medical Guideline Information Center (KoMGI) are in charge of developing evidence-based clinical practice guidelines and sharing developed guidelines. KoMGI provides basic information on clinical practice guidelines development methodologies and evaluation methods to academic societies and domestic medical professionals for the purpose of making the Korean Academy of Medical Sciences use the information to develop and distribute evidence-based medical care and clinical practice guidelines and apply them to the medical field. In addition, KoMGI provides basic information on clinical care guidelines development methodologies to domestic medical professionals and distributes developed clinical practice guidelines developed by academic societies in Korea or the Korean Academy of Medical Sciences to improve the access to and use of clinical practice guidelines that are already developed. In addition, it is making an effort to improve the quality of domestic clinical practice guidelines by evaluating the quality of the guidelines using an objective and valid method (AGREE II). Until 2017, about 295 types of domestic clinical practice guidelines had been registered since 1994 when thefirst guideline for adult asthma treatment was registered with KoMGI.
The National Evidence-based Healthcare Collaborating Agency published theSystematic Literature Review Manual (2011), the Clinical Practice Guidelines Development Manual (2011), and theHandbook for the Application of Clinical Practice Guidelines (2015) and provides training on research methodology for the development of clinical practice guidelines.
Internationally, most advanced countries consider the development of clinical practice guidelines as one of the major policy tasks under the goal of improving the quality of care and manage it and provide financial support under the leadership of the state. In 2002, the Guideline International Network (GIN), which is an international clinical practice guidelines network, was established with an aim to develop effective and high-quality clinical practice guidelines in the medical field by holding international academic conferences, organizing region-specific communities, and forming theme-specific working groups. In addition, international organizations such as the EU and WHO are participating in activities to share information on clinical practice guidelines, and it shows that clinical practice guidelines are a global trend and their use and importance in clinical practice are expected to increase further.
In the case of the U.S. and the UK where the development and management of clinical practice guidelines are systematically undertaken by the state, the Agency for Healthcare Research and Quality (AHRQ) under the U.S.Department of Health and Human Services is in charge of this area in the U.S., and organizations such as the National Institute for Health and Care Excellence (NICE), National Guideline Centre (NGC), and Scottish Intercollegiate Guidelines Network (SIGN) are in charge of such work in the UK.

State of DB on Clinical Practice Guidelines Run by

DB name Operating entity Continent (country) Purpose Website
GIN GIN International cooperation To promote communication, participation, and cooperation among clinical practice guideline developers, share a variety of support tools and publications, and strengthen the development of clinical guidelines and dissemination of knowledge Link
IRIS WHO International cooperation The guidelines of the WHO are developed based on advice from WHO member countries and an advisory process where national and international organizations participate. WHO discloses various publications including clinical practice guidelines. Link
AHRQ AHRQ U.S. To create evidence to make healthcare safer, have higher quality, more accessible, equitable, and economical and collaborate with partners who understand and use the evidence Link
SIGN Healthcare Improvement Scotland England, Scotland To reduce variation in treatment and outcomes by developing and disseminating evidence-based clinical practice guidelines Link
NICE NICE England To pursue and realize excellence across the whole health and social security systems Link
NCGC(NGC) NCGC(NGC) England To disclose clinical practice guidelines that are already developed or being developed at the request of NICE or by the RCP itself and policy decisions Link
NCCIH NCCIH U.S. It is installed to lead scientific research on various medical and health management systems that are not included in the scope of conventional medicine.
NCCN NCCN U.S. To describe evidence-based agreed recommendations to make sure that all patients receive the best possible prevention, diagnosis, treatment, and supportive treatment
ICSI ICSI U.S. To develop evidence-based clinical practice guidelines to promote patient care
USPSTF AHRQ U.S. To improve the health of all Americans by establishing evidence-based recommendations for clinical preventive services
NHMRC NHMRC Australia To facilitate the development of clinical practice guidelines and information sharing among developers by making developers develop and register evidence-based clinical practice guidelines being developed in Australia
CMAJ CMAJ Canada Unlike other clinical practice guidelines, it attempts to approach realistic differences in health-related topics of Alberta. It provides evidence and recommendations that may influence decision-making regarding the clinical gap.
TOP CPGs TOP U.S. To improve the health of all Americans by establishing evidence-based recommendations for clinical preventive services
BC Guidelines GPAC Canada It is developed to support effective use of medical services, high-quality, and appropriate patient care.
RNAO RNAO Canada The program has been underway for many years to provide the best clinical practice guidelines for patients in Ontario.
CTFPHC CTFPHC Canada Clinical practice guidelines are being developed to support primary care providers who provide preventive health care.
HAS HAS France HAS is conducting various activities such as evaluation of medicines and medical devices, evaluation of treatment methods, and interventions, economic evaluation, publication of clinical guidelines, certification of medical institutions, evaluation of social welfare services and facilities, evaluation and improvement of quality of care and patient safety, and certification of doctors and medical teams. It also strengthens efforts in the two major areas of medical technology evaluation and improvement of quality of care and patient safety at the European and international levels.
AWMF AWMF Germany It plays an important role such as providing advice on important and multidisciplinary issues in the medical field, development of medical guidelines, research, education, and training on healthcare, internal cooperation between medical and scientific organizations, improvement of healthcare quality, and healthcare policy decision-making.
MOH Ministry of Health Singapore To improve public health, reduce diseases and provide improved healthcare, guarantee access to affordable medical services, and promote excellence of medicine
ACE Ministry of Health Singapore To optimize the health benefits with limited resources, provide care based on evidence, and improve treatment values by publishing objective and reliable medical guidelines
Minds JCQHD Japan To improve the quality and safety of healthcare, guarantee a reliable medical system, and contribute to public health and welfare
IPGRP Lanzhou University EBM center China To provide a free, open international platform for clinical practice guidelines under development, improve the transparency in the development of guidelines, prevent duplication and promote cooperation dissemination among developers, and facilitate the implementation of the guidelines
NCKM G-KoM Korea It is intended to spread and disseminate Korean medicine clinical practice guidelines based on the Project to Develop Korean Medicine Standard Clinical Practice Guidelines. It systemizes the process of developing clinical guidelines such as development, certification, and dissemination of guidelines and confirming additional needs.
KOMGI KAMS Korea To disseminate and monitor web-based clinical practice guidelines, conduct workshops for CPG developers and users, and support and certify the development of guidelines
The development of clinical practice guidelines in traditional medicine is led by China, Japan, and the Republic of Korea. Chinese clinical practice guidelines have been developed since 2003 when professionals made an agreement, and the development of Chinese medicine clinical guidelines started in 2011 with the support of the WHO. Based on clinical studies conducted in China and studies found in the literature, a multidisciplinary group has been publishing theGuidelines for Evidence-Based Clinical Practice of Traditional Chinese Medicine (中醫循證臨床實踐指南). The series consists of a total of 31 diseases in three broad areas: Chinese internal medicine, acupuncture, and specialty. It provides detailed information on the introduction of diseases, background, clinical characteristics, and diagnostic criteria and describes the level of recommendation and evidence systematically. For Chinese medicine clinical practice, guidelines for 29 diseases have been published as of March 2018, and there are separate guidelines for acupuncture treatments for shingles, Bell’s palsy, depression, pseudobulbar palsy, and migraine, so it can be said that the development of medical guidelines for Chinese medicine is more specific than that of Korean medicine guidelines.

In Japanese Oriental medicine, the Japan Society for Oriental Medicine is steadily making efforts to make Oriental medicine scientific. In the 2000s, the Japan Society for Oriental Medicine pursued evidence-based medical methodologies for the vitalization of Oriental medicine. In 2002, 833 clinical theses on the use of Oriental medicine that had been published since 1986 were reviewed from the perspective of evidence-based medicine, and they were divided into clinical evidence and research methodologies. The review results were published in the report “The Oriental Treatment Evidence Report 2010” published by the EBM Committee in 2010 and included the results of 345 randomized clinical trials and meta-analysis results of papers on various diseases. “The Oriental Treatment Evidence Report 2013” developed in 2013 introduced the results of 402 randomized clinical trials.
In Korean Oriental medicine, the need for Oriental medicine clinical practice guidelines has emerged as a way to make Oriental medicine more scientific, improve equality of care, and approach patients with reasonable primary care. Through the Oriental medicine leading technology R&D project led by the Ministry of Health and Welfare, which started in 2008, clinical guidelines on Hwabyung (Korean somatization disorder) and musculoskeletal diseases were published in 2013. The Korean Academy of Medical Sciences and the Association of Korean Medicine developed clinical practice guidelines on Sasang constitutional disease, Sanghanron prescription protocol, infertility, traffic accident injury syndrome,acupuncture for smoking cessation, swine flu, cervical spine disease, luminary spine disease, obesity, high blood pressure, and diabetes. In addition, the Korea Institute of Oriental Medicine has published guidelines based on systematic methodologies for frequent diseases such asfacial nerve palsy, luminous disc herniation, atopic dermatitis, scapular pain, sprains, obesity, and depression. It presented the methodologies for systematic development of clinical practice guidelines incorporating the reality of Oriental medicine through its guideline on the development and reporting of Oriental medicine clinical practice guidelines. It also holds the International Symposium of Evidenced-based Clinical Practice Guideline in Traditional Medicine to explore the methodologies for clinical practice guidelines for traditional medicine and ways for development. The Oriental Medicine Standard Clinical Practice Guidelines Development Project Group selected 30 diseases in 2016 and has been developing clinical practice guidelines and preparing for certification.

Comparison of Development of Oriental Medicine Clinical Practice Guidelines among Korea, China, and Japan

China Japan Korea
Development agency Chinese Academy of Sciences (supported by WHO) Japan Society for Oriental Medicine Oriental Medicine Standard Clinical Practice Guidelines Development Project Group
Clinical practice guideline name Guidelines for Evidence-Based Clinical Practice of Traditional Chinese Medicine Oriental Treatment Evidence Report Oriental Medicine Standard Clinical Practice Guidelines
Development methodology Use expert consensus and evidence-based methodology Review and develop various clinical studies including randomized clinical trials (RCT) Use evidence-based methodology studied by the GRADE group was modified and used
Level of evidence and recommendations Recommended as A？C according to the level of evidence and recommendation grade of Chinese medicine Uses its own recommendation grade; it is recommended as A？D according to the existence of a citation paper or the level of evidence/recommendation grade Evidence level high, moderate, low, very low, CTB (classical textbased) and recommendation grades A？D, GPP
Characteristics of clinical practice guidelines Presents an overview of diseases, background, clinical characteristics, diagnostic standards, prognosis, and management in textbook format Presents effective prescription according to Western medical diagnosis Presents clinical questions, the process of deriving the level of evidence/recommendation level, and final recommendations, synthesizes the latest domestic and international evidence, and develops recommendations through expert consensus to secure an international level of methodological rigor and includes clinical pathways that can be widely used in clinical settings based on objective evidence and expertise of clinicians