The ingredients of a Clinical Practice Guideline: an exploration of the diversity of research approaches on practice.

Jennifer L Hefner, Patrick Feng, Lori Peterson, Ann McAlearney, Eric Ford, Timothy Huerta, Caitlin Tallant



A qualitative assessment of the research used in the development of a widely used Clinical Practice Guideline (CPG) to gain insight into the kinds of evidence that informs the development of CPGs.


All articles cited within the 2003 Canadian Pediatric Asthma Consensus Guideline (“the Guideline”) were secured, as was the literature cited by these articles. Two independent reviewers coded all 98 articles referenced by the Guideline (“primary citations”), and the 3,167 articles referenced by the primary citations (“secondary citations”), along three schemes: article type, research design and article orientation.


Among the primary and secondary citations Clinical research was the most represented type (53%), followed by Health Services (25%), Population Health (18%), and Biomedical (4%). There was a strong interdependence between Clinical and Health Services Research articles with each type frequently citing the other. Observational study designs were most common (48%), followed by experimental studies (31%) and secondary research (21%).


While CPGs rely on significant support from clinical or biomedical randomized controlled trials, the translation of research into practice is non-linear with an important role for Health Services Research and Population Health. This may have implications for funding agencies and other supporters of health research who are working to bridge the gap between research and clinical practice.


Practice Guidelines, Research Funding Policy, Evidence Base

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Field, M.J., Setting priorities for clinical practice guidelines. 1995: National Academies Press.

Hutchinson, A., et al., Developing primary care review criteria from evidence-based guidelines: coronary heart disease as a model. The British journal of general practice : the journal of the Royal College of General Practitioners, 2003. 53(494): p. 690-696. http://bjgp.org/content/bjgp/53/494/690.full.pdf

Vickrey, B.G., et al., The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Annals of Internal Medicine, 2006. 145(10): p. 713-726. http://annals.org/data/Journals/AIM/20126/0000605-200611210-00004.pdf

Banzi, R., et al., Conceptual frameworks and empirical approaches used to assess the impact of health research: an overview of reviews. Health research policy and systems / BioMed Central, 2011. 9: p. 26-4505-9-26. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141787/pdf/1478-4505-9-26.pdf

Lewison, G. and R. Sullivan, The impact of cancer research: how publications influence UK cancer clinical guidelines. British journal of cancer, 2008. 98(12): p. 1944-1950. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2441955/pdf/6604405a.pdf

Ovseiko, P.V., A. Oancea, and A.M. Buchan, Assessing research impact in academic clinical medicine: a study using Research Excellence Framework pilot impact indicators. BMC health services research, 2012. 12: p. 478-6963-12-478. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556502/pdf/1472-6963-12-478.pdf

Kryl, D., et al., Tracking the impact of research on policy and practice: investigating the feasibility of using citations in clinical guidelines for research evaluation. BMJ open, 2012. 2(2): p. e000897-2012-000897. Print 2012. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317168/pdf/bmjopen-2012-000897.pdf

Quality, A.f.H.C.R., Recommendations of the U.S. Preventive Services Task Force: Abstract. 2010.

Atkins, D., et al., Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC health services research, 2004. 4(1): p. 38. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC545647/pdf/1472-6963-4-38.pdf

Atkins, D., et al., Grading quality of evidence and strength of recommendations. BMJ (Clinical research ed.), 2004. 328(7454): p. 1490. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC428525/pdf/bmj32801490.pdf

McAlister, F.A., et al., How evidence-based are the recommendations in evidence-based guidelines? PLoS medicine, 2007. 4(8): p. e250. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1939859/pdf/pmed.0040250.pdf

Woolf, S., et al., Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations. Implementation science : IS, 2012. 7: p. 61-5908-7-61. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3436711/pdf/1748-5908-7-61.pdf

Price, D. and M. Thomas, Breaking new ground: challenging existing asthma guidelines. BMC pulmonary medicine, 2006. 6 Suppl 1: p. S6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698499/pdf/1471-2466-6-S1-S6.pdf

Grant, J., et al., Evaluating "payback" on biomedical research from papers cited in clinical guidelines: applied bibliometric study. BMJ (Clinical research ed.), 2000. 320(7242): p. 1107-1111. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27352/pdf/1107.pdf

Canadian Institutes of Health, R., An Overview of CIHR. 2008.

Concato, J., Observational versus experimental studies: what's the evidence for a hierarchy? NeuroRx : the journal of the American Society for Experimental NeuroTherapeutics, 2004. 1(3): p. 341-347. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC534936/pdf/neurorx001000341.pdf

Barley, S.R., G.W. Meyer, and D.C. Gash, Cultures of culture: Academics, practitioners and the pragmatics of normative control. Administrative Science Quarterly, 1988: p. 24-60.

Becker, A., et al., Summary of recommendations from the Canadian Asthma Consensus guidelines, 2003. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2005. 173(6 Suppl): p. S3-11. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1329945/pdf/20050913.1s00001pS3.pdf

DOI: http://dx.doi.org/10.18103/mra.v0i3.238


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