Updating the Guideline Methodology of the Healthcare Infection Control Practices Advisory Committee (HICPAC)
Organizing to Accomplish Our Goals
In order to reengineer its guideline development process, HICPAC first restructured its approach. In its new approach, each guideline is developed by a working group in consultation with a panel of content experts and HICPAC (Figure 1). All funding is provided by CDC. Financial conflicts of interest are vetted and disclosed for all working group, content experts, and HICPAC members.
The working group has accountability for all phases of methodology, including development of the key questions around which the guideline is based, the systematic review of the evidence, and the guideline itself. It also is responsible for providing content experts and HICPAC members with progress updates at agreed-upon dates. Each working group includes but is not limited to three main stakeholders: a HICPAC member, a staff member from CDC, and outside experts in the methodology of guideline development. Each member has individual as well as overlapping accountabilities.
The HICPAC member is responsible for helping to develop the key questions, reviewing abstracts and full text articles for inclusion in the guideline, reviewing summaries of the evidence and the guideline recommendations, and communicating progress of the working group at regular HICPAC meetings, as well as communicating progress to and soliciting input from experts who are external to HICPAC.
The CDC staff member comes from the Division of Healthcare Quality Promotion in the National Center for Preparedness, Detection and Control of Infectious Diseases, and responsibilities include helping to develop key questions, reviewing abstracts and full text for inclusion, and writing the evidence summaries and recommendations as well as the following guideline sections: the executive summary, summary of recommendations, implementation and audit, recommendations for further research and background.
The experts in guideline methodology include a project manager, an analyst, and a medical librarian. The role of the project manager includes developing and maintaining guideline methods, setting the timeline, and reviewing and integrating all aspects of guideline development. The analyst extracts data from included studies, builds evidence tables, and grades the overall quality of the evidence for guideline questions using formal processes. The librarian assists the working group in developing search strategies and choosing resources to find relevant references, run searches, and manage included and excluded references.
The panel of content experts consists of three or more content experts both internal and external to HICPAC. These experts are chosen at the discretion of HICPAC. The expert panel participates and provides feedback in regular progress updates, and provides in-depth reviews of key questions, the bibliography resulting from the initial literature search, the draft evidence report, and guideline recommendations.
HICPAC members and liaisons participate in the guideline development process and provide feedback in regular progress updates, as well as on the draft evidence report and guideline recommendations. HICPAC members then vote to approve the final guideline.
The expertise and experience of relevant professional societies is also critical to this process. As such, representatives of these societies can participate through multiple routes, including as HICPAC liaisons, content experts, or working group members.