Best Websites for Official Medical Guidelines
The National Guideline Clearinghouse (http://www.guidelines.gov) is the primary recommended resource for finding evidence-based clinical practice guidelines, as it is a public resource supported by the Agency for Healthcare Research and Quality that indexes only guidelines meeting rigorous criteria including systematic evidence review and documented assessment of benefits and harms. 1
Primary Government and Professional Society Resources
Federal Government Sites
- Centers for Disease Control and Prevention (CDC) - Provides evidence-based guidelines across multiple clinical domains 1
- National Heart, Lung, and Blood Institute (NHLBI) (http://www.nhlbi.nih.gov/guidelines/) - Offers comprehensive cardiovascular and pulmonary guidelines including cholesterol management, hypertension (JNC reports), and obesity guidelines 1
- FDA Heart Health (http://www.fda.gov/hearthealth/index.html) - Provides patient and provider resources for cardiovascular conditions 1
- Surgeon General's Office (http://www.surgeongeneral.gov) - Publishes guidelines on tobacco cessation and other public health topics 1
Professional Medical Society Websites
- American Heart Association (http://www.americanheart.org) - Publishes cardiovascular disease prevention and treatment guidelines, including the "Get With the Guidelines" program 1
- American College of Cardiology - Offers the "Guidelines Applied in Practice" tools and ACC/AHA joint guidelines 1
- American Diabetes Association (http://www.diabetes.org) - Provides diabetes management guidelines 1
- European Society of Cardiology (http://www.escardio.org/knowledge/guidelines) - Publishes comprehensive European clinical practice guidelines with transparent methodology 1
How to Identify High-Quality Guidelines
Essential Quality Criteria
- Systematic evidence review - Guidelines must be based on comprehensive systematic reviews, not expert consensus alone 1
- Transparent methodology - The development process should be clearly documented with evidence grading systems (such as GRADE or SORT) 1
- Conflict of interest disclosure - All panel members' potential conflicts must be disclosed and managed 1
- Patient-oriented outcomes - Strong recommendations should be based on studies showing improvements in morbidity, mortality, and quality of life rather than surrogate markers 1
- Recent evidence - Guidelines should document the publication date of the most recent evidence reviewed 1
Red Flags to Avoid
- "Consensus-based" or "expert opinion" guidelines without systematic evidence review should generally be avoided, as these are subject to bias regardless of documentation 1
- Guidelines with increasing proportions of recommendations lacking conclusive evidence (a trend noted in some ACC/AHA guidelines from 1998-2008) 1
- Guidelines recommending treatment based solely on disease-oriented outcomes (like laboratory values) without patient-oriented evidence 1
Validation Tools
The AGREE II instrument is the most validated tool for appraising guideline quality, assessing 23 items across 6 domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence 1
Simplified Clinician Assessment
For busy clinicians, focus on four key questions 1:
- Was the recommendation based on best available evidence that is clearly reported?
- Were patients' values, preferences, and resources considered?
- Was the strength of recommendations appropriate to the evidence quality?
- Was the influence of conflicts of interest minimized?
Additional Specialized Resources
- MedlinePlus tutorials (http://www.nlm.nih.gov/medlineplus/tutorial.html) - Patient education materials aligned with evidence-based guidelines 1
- National Quality Measures Clearinghouse - Provides quality indicators linked to guideline recommendations 1
- Professional society websites relevant to specific clinical topics should be searched directly for specialty-specific guidelines 1