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How Quickly Do Guidelines Become Outdated?

Paul G. Shekelle, MD,PhD; Eduardo Ortiz, MD,MPH; Shannon Rhodes, MFA; Sally C. Morton, PhD; Martin P. Eccles, MD; Jeremy M. Grimshaw, MD; Steven H. Woolf, MD,MPH

JAMA. 2001;286:1461-1467.

Context  Practice guidelines need to be up-to-date to be useful to clinicians. No published methods are available for assessing whether existing practice guidelines are still valid, nor does any empirical information exist regarding how often such assessments need to be made.

Objectives  To assess the current validity of 17 clinical practice guidelines published by the US Agency for Healthcare Research and Quality (AHRQ) that are still in circulation, and to use this information to estimate how quickly guidelines become obsolete.

Design, Setting, and Participants  We developed criteria for defining when a guideline needs updating, mailed surveys to members of the original AHRQ guideline panels (n = 170; response rate, 71%), and searched the literature for evidence through March 2000 (n = 6994 titles yielding 173 articles plus 159 new guidelines on the same topics).

Main Outcome Measures  Identification of new evidence calling for a major, minor, or no update of the 17 guidelines; survival analysis of the rate at which guidelines became outdated.

Results  For 7 guidelines, new evidence and expert judgment indicated that a major update is required; 6 were found to be in need of a minor update; 3 were judged as still valid; and for 1 guideline, we could reach no conclusion. Survival analysis indicated that about half the guidelines were outdated in 5.8 years (95% confidence interval [CI], 5.0-6.6 years). The point at which no more than 90% of the guidelines were still valid was 3.6 years (95% CI, 2.6-4.6 years).

Conclusions  More than three quarters of the AHRQ guidelines need updating. As a general rule, guidelines should be reassessed for validity every 3 years.

Author Affiliations: Southern California Evidence-Based Practice Center/RAND Health Division, Santa Monica (Drs Shekelle and Morton and Ms Rhodes); Greater Los Angeles Veterans Affairs Health Care System, Los Angeles, Calif (Dr Shekelle); Department of Medicine, University of California, San Diego, and San Diego Veterans Affairs Health Care System, San Diego (Dr Ortiz); Centre for Health Services Research, University of Newcastle Upon Tyne, Newcastle Upon Tyne, England (Dr Eccles); Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland (Dr Grimshaw); and Department of Family Practice, Virginia Commonwealth University, Richmond (Dr Woolf).

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