Evidence Based Laboratory Medicine Committee Update
Report from the
AACC/NACB Evidence Based Laboratory Medicine Committee
Stephen E. Kahn, Ph.D., DABCC, FACB (Chair, EBLMC)
Revision of the NACB Laboratory Medicine Practice Guideline (LMPG) Standard Operating Procedure (SOP) to Be Posted on NACB Website
Over the past six months, the AACC/NACB Evidence-Based Laboratory Medicine Committee (EBLMC) has focused on finalizing the revision of NACB's LMPG SOP. This function became the responsibility of the EBLMC once it was created by merging the previous AACC Evidence Based Medicine Committee and NACB Education and Scientific Affairs Committee. During their spring meetings, both the NACB and AACC Board of Directors are also reviewing this current draft of the LMPG SOP. Following their review and input, a proposed final draft will then be posted on the NACB web site for a 60 day open public comment period. This action is planned to occur before this year's annual meeting in Houston. All submitted comments will be considered and responded to, if not incorporated by, the EBLMC.
Laboratory Management Practice Guideline Development Activities
In the past two years, a renewed emphasis on appropriate methods, tools and processes for the development of stronger clinical practice guideline has received increasing attention. This is particularly true in the U.S. with the publication of two reports by the Institute of Medicine–Clinical Practice Guidelines We Can Trust (1) and Finding What Works in Health Care–Standards for Systematic Reviews (2). There are two working LMPG committees. One group is focusing on pain management and is co-chaired by Paul Jannetto, Ph.D. and Loralie Langman, Ph.D. The other LMPG group is chaired by Nikola Baumann, Ph.D. and is focusing on hCG testing. Both committee are already using a working draft of the 2013 NACB LMPG SOP.
Besides the LMPG SOP revision, there are a number of other approaches that the EBLMC is using towards a goal of improving our LMPG development and guideline approval processes. Last year, William Clarke, Ph.D., attended a two day guideline development workshop sponsored by the American College of Chest Physicians, a clinical society that is recognized worldwide for its excellent practices in guideline development. As a member of both the EBLM and Pain Management LMPG committees, Dr. Clarke's experience and knowledge is being put to good use.
Two other members of the EBLMC, Alex Chin, Ph.D. and Catherine Hammett Stabler, Ph.D., members of the hCG LMPG and pain management LMPG committees respectively, have also agreed to develop their expertise in using the AGREE II guideline evaluation instrument to ensure a more standardized LMPG format. Information on the AGREE II guideline evaluation instrument can be found at www.agreetrust.org (3) and has been previously discussed (4)
Status of EBLMC Initiated Systematic Review Proposals to the Agency for Healthcare Research and Quality (AHRQ)
Three topic-based systematic review (SR) proposals continue in intermediate stages of development by Technical Expert Panels (TEPs) under the auspices of AHRQ. Use of natriuretic peptide measurements in the management of heart failure is nearing completion and publication of a final SR report is expected in 2013. Our TEP members are Robert Christenson, Ph.D. and Christopher Price, Ph.D. The scope and focus of efficacy of drug regimens designed to lower target levels of immunosuppressants in renal transplantation and the analytical methods to support monitoring has continued to evolve. Susan Maynard, Ph.D., our representative on this TEP, has been informed that AHRQ is willing to retain a focus on immunosuppressant testing for a secondary systematic review developed from two of the original five key questions in the initial proposal. Finally, the TEP working on troponin cardiac marker interpretation during renal function impairment has started starting). Alan Wu, Ph.D., is our representative on this TEP.
In the fall of 2012, AHRQ finalized and posted a SR on the use of procalcitonin measurements to guide antibiotic therapy. This was also a topic arising from an initial proposal from the EBM committee and with TEP representation from myself as a member of the EBLMC. EBLMC continues to consider whether there are other appropriate topics or key questions for SR proposals to AHRQ potentially including a greater emphasis on effective utilization of laboratory tests. This committee plans to submit proposals to AHRQ later this year. Through the use of AACC's EBLM list serve, we will continue to keep you posted on relevant actions and issues relating to EBLM. Also through the list serve or by contacting me via direct email, we welcome your input and suggestions.
- Clinical Practice Guidelines We Can Trust, Institute of Medicine, The National Academies Press, Washington, D.C., 2011.
- Finding What Works in Health Care – Standards for Systematic Reviews, Institute of Medicine, The National Academies Press, Washington, D.C., 2011.
- The AGREE Enterprise Website. Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument. www.agreetrust.org
- Brouwers MC et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 2010; 182(18): e839-42.