Peer Review in Guideline Development

Peer Review in Clinical Guideline Development

Peer review is an integral part of guideline development and revision. The IOM/NAM standard 2.3 suggests that the systematic review team obtain input from the target audience (end users) of the guideline and from stakeholders (eg, professional organizations whose membership may be impacted by the guideline) from the outset. The standard goes on to state that the independence of the review team to make final decisions about the design, analysis and reporting of the review should be protected.

People with an obvious conflict of interest (COI) are excluded. It is prudent to include generalists, content experts, and the caregiver perspective (such as the AAP FamilY Partnership Network) in the peer review process. The AAP typically provides a review period of 30 calendar days. Guidelines typically include implications for populations across several clinical fields, so the AAP is generously inclusive when inviting groups and organizations to participate in the peer review process. Thus, review from specialty groups both within and external to the authors’ primary affiliation is mandatory. The AAP will routinely send guidelines to internal groups as appropriate. 

Internal Review

The AAP has a 2-step review process. As the guideline subcommittee approaches completion of the draft manuscript, it may reassess the internal stakeholders that should participate in the peer review process by reviewing the AAP’s roster of national councils, committees, sections, and other groups. These determinations are typically made when the guideline topic proposal is submitted but usually are revisited and finalized as the completion of the draft guideline approaches. Specific recommendations for peer reviewers should accompany the request for review and are given below.  

The process begins with selection of invited reviewers. The Council on Quality Improvement and Patient Safety (COQIPS) always serves as the first reviewing group and must approve the guideline (as written or with recommended edits) before it advances to other groups for review and comment. In addition to COQIPS, several internal groups are mandatory reviewers of all guidelines, including the Committee on Medical Liability and Risk Management (COMLRM), the Committee on Practice and Ambulatory Medicine (COPAM), and the Committee on Child Health Financing (COCHF). 

Role of COQIPS and the Committee on Guideline Development (COGD)

COQIPS reviews and scores all guideline topic submissions. COQIPS serves in an advisory, consultative, and coordinative role.4 Their charge is to avoid duplication in the development of AAP clinical practice guidelines and to assist in the adherence to AAP organizational and methodologic processes for guidelines in accordance with available resources. As such, COQIPS reviews all preliminary topic submissions and prioritizes those that will be approved to move forward for consideration by AAP Board of Directors.  

The COGD is a committee within the COQIPS. The COGD ensures that published guidelines meet predetermined standards for evidence-based clinical guidelines, including the following areas: 

  • Methodology, including the classification and interpretation of evidence;  

  • Evaluation of recommendations for cost, feasibility, usability, and ethical and clinical soundness; 

  • Appropriate use of references; and  

  • Transparency of conflicts of interest. 

External Peer Review

External expert groups are also identified when the subcommittee revisits the list of pertinent stakeholders that should participate in the peer review process. Peer review is the first step toward securing endorsement from other appropriate bodies and is useful for ensuring that all relevant stakeholder perspectives are considered. Stakeholders from a variety of practice settings is important, because practicality is an issue. What can be accomplished in an academic center serving a large population may not be feasible for smaller, more rural practices, or practices with a different demographic composition. 

The Section on Epidemiology, Public Health, and Evidence (SOEPHE [as represented by the methodologist]) and COQIPS will be involved in ensuring that the path from evidence to recommendation is transparent. Relevant COIs (eg, financial, industry-relationships, intellectual) of the authoring team will be documented in the manuscript. When all comments are received, significant concerns with the manuscript are sent to the AAP Board Policy Committee, which will work with the authoring team to address these concerns. After concerns have been addressed and consensus reached by the peer reviewers providing the significant concerns, the evidence-based clinical guideline is ready for internal copyediting, followed by internal leadership review and publication in Pediatrics. 

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