gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Dynamic Updating of Clinical Practice Guidelines (CPGs)

Meeting Abstract

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  • C. Robbins - Kaiser Permanente-Care Management Institute, Oakland, CA, United States; Colorado Permanente Medical Group, Denver, CO, United States; University of Colorado School of Medicine-Department of Family Medicine, Denver, CO, United States
  • G. Tom - Kaiser Permanente-Care Management Institute, Oakland, CA, United States

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocO08

doi: 10.3205/12gin040, urn:nbn:de:0183-12gin0409

Published: July 10, 2012

© 2012 Robbins et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: We have been developing CPGs for use within our organization since 2002. Our current guideline portfolio includes nearly 200 clinical questions across 17 guideline topics. We continue to receive requests to add more clinical questions. However, the resources to develop and maintain our CPGs remain fixed. We have decided to update individual clinical questions on an as needed basis instead of updating entire guidelines at fixed intervals.

Context: Other organizations involved in guideline development face similar resource constraints and are looking into similar solutions to these challenges. For example, the ACP is working to create 'Living Guidelines' wherein clinical questions are updated on an as needed basis.

Description of Best Practice: We continuously monitor all the clinical questions in our guideline portfolio. We identify the top priority clinical questions by gathering input from our clinical experts and updating literature searches using existing search strategies. Once selected, we use one or more of the following strategies to update our recommendations: Adopt/adapt external guidelines (ADAPTE/AGREE); Use or update an existing systematic review (GRADE); Conduct our own systematic review (GRADE).

Using examples from our experience, we will share the following lessons learned: Updating clinical questions in a rigorous way is labor intensive regardless of whether external guidelines or systematic reviews are available to use; Concentrating our evidence analyst resources on the clinical questions most in need of updating helps balance efficiency and rigor in our guideline development processes.