An analysis of clinical practice guidelines archived on the National Guideline Clearinghouse (NGC) website as of June 2011 demonstrated poor compliance with Institute of Medicine (IOM) standards, with little if any improvement over the past 2 decades, say authors of an article published this month in Archives of Medicine. 

For the study, 2 reviewers independently screened 130 guidelines selected at random from NGC's website for compliance with 18 of 25 IOM standards.

The overall median number of IOM standards satisfied (out of 18) was 8 (44.4%). Fewer than half of the guidelines surveyed met more than 50% of IOM standards. Barely a third of the guidelines produced by subspecialty societies satisfied more than 50% of the IOM standards surveyed.

Information on conflicts of interest was given in fewer than half of the guidelines surveyed. Non-English literature, unpublished data, and/or abstracts were rarely considered in developing guidelines. Differences of opinion among committee members generally were not aired in guidelines. Benefits of recommendations were enumerated more often than potential harms. Guidelines published from 2006 through 2011 varied little with regard to average number of IOM standards satisfied.

"Everybody everywhere is developing guidelines and there is no real quality control," lead author Philip A. Mackowiak, MD, told Reuters News. "There is no good oversight of who actually develops the guidelines or what criteria need to be met in order for them to be published."

IOM's standards were not published until 2011. Mackowiak acknowledges that the experts who developed the guidelines reviewed by his team would not have been able to use IOM's standards.  However, he added that similar standards have been published before and that they were basic enough that they should have been followed, says Reuters.