Table 1

Institute of Medicine standards for developing trustworthy clinical practice guidelines1

Establishing transparencyExplicit and publically accessible process
Management of conflict of interestGuideline members should disclose all potential conflicts and divest when necessary
The group should limit the number of members with conflicts
Guideline development group compositionThe group should be multidisciplinary and balanced
Patient and public involvement should be facilitated
Clinical practice guidelines—systematic review intersectionUse or commission high-quality systematic reviews

Establishing evidence foundations for, and rating strength of, recommendationsExplain reasoning for recommendations
Rate the level of confidence and strength of the recommendation
Articulation of recommendationsExplicitly detail the recommended action and circumstances for performing a recommended action
Strong recommendations should be worded to facilitate compliance evaluations
External reviewExternal reviewers should comprise a full spectrum of relevant stakeholders
Reviewers’ identities should be kept confidential
Responses to reviewer comments should be recorded
Draft guidelines should be available for public comment
UpdatingRegularly monitor literature
Plan periodic updates
Modify recommendations when important new evidence emerges