Team Selection and Conflicts of Interest


Clinical Practice Guideline Team Selection and Conflicts of Interest

The ideal size of a CPG subcommittee is 10-14 members, not counting AAP staff. The final size may be influenced by balancing the need for appropriate team dynamics with funding availability. At a minimum, the team includes a Chair, a Vice Chair, a methodologist/ epidemiologist, a Partnership for Policy Implementation (PPI) representative, an implementation scientist, content experts, general pediatricians, stakeholders from relevant disciplines, a family representative, a Guideline Coach, and AAP staff. As much as possible, the subcommittee should strive for diversity in membership. Typically, guideline subcommittees participate in a kick-off videoconference, two face-to-face meetings, and teleconferences (as needed). Note: Proposal of panel members does not guarantee their participation.

    Chair Selection and Qualifications
    Upon receipt of all CPG subcommittee Chair nominations, the Chair is recommended by the COGD to the COQIPS Chair. With approval from the COQIPS Chair and input from guidelines staff, the CPG subcommittee Chair is submitted for review and approval by the AAP EC. Qualifications of the Chair include:

    • The Chair should be a current AAP member (FAAP) and represent the primary audience to whom the guideline’s recommendations are directed. In most situations, this means the Chair should be a practicing general pediatrician. However, if the guideline primarily targets another discipline (e.g., pediatric emergency medicine, neonatology, etc.), the Chair should come from that discipline. Subspecialist Chairs may be considered if their subspecialty is expected to be targeted by the recommendations. If the guideline subcommittee shares concerns regarding inclusivity and/or transparency, or identifies other issues with the CPG Chair, the COQIPS Chair in collaboration with the GETS Committee will resolve the concerns expediently. 
    • Should have been in active practice in her/his primary specialty within the past 5 years. 
    • Should have prior experience with evidence-based CPG development (including membership on a previous AAP CPG subcommittee, or equivalent experience). 
    • Must have demonstrated leadership ability. 
    • Must be efficient and motivated. 
    • Must have demonstrated skills in scientific writing. 
    • Must be familiar with the CPG development process as outlined here and the AAP policy "Toward Transparent Clinical Policies."
    • Must adhere to the AAP Policy “Conflict of Interest and Relationships with Industry and Other Organizations.”  
    Vice Chair Selection and Qualifications
    The Vice Chair of the CPG subcommittee is selected by the Chair with input from AAP staff. Qualifications of the Vice Chair include: 

    Methodologist/Epidemiologist Selection and Qualifications
    The Section on Epidemiology, Public Health, and Evidence (SOEPHE) is first contacted for applicants for methodologist/epidemiologist for the specific CPG subcommittee. The CPG subcommittee Chair and AAP staff will review credentials of volunteers for this position. The CPG Chair will select the methodologist/epidemiologist with input from AAP staff. Qualifications of the methodologist/epidemiologist include: 

    • Prior CPG development or similar experience;  
    • Familiarity with guideline methodology; 
    • Familiarity with the process of systematic reviews; 
    • Direct experience with prior guidelines; 
    • Familiarity with the CPG development process as outlined here and the AAP policy "Toward Transparent Clinical Policies."

    Partnership for Policy Implementation (PPI) Representative Selection and Qualifications
    The PPI was established to increase the ability of pediatricians to implement AAP recommendations at the point of care. A PPI nominee is submitted to guideline staff for consideration to participate on every AAP guideline as a member of the CPG subcommittee. This member will aid in the production of clear guidance on how pediatricians can implement recommendations. When a PPI member is selected to serve on the current PPI group, he or she will shadow on at least one project prior to being the primary member assigned to a guideline or policy statement.  

    Recommended qualifications for the PPI representative include: 

    • Clinical informatician, ideally board certified in clinical informatics.
    • Ability to use Bridge-Wiz and/or other tools to make recommendations implementable/computable.
    • The ability to create model clinical decision supports such as order sets/rules/forms.
    • Ability to map relevant terms to standard clinical computer vocabularies for potential inclusion in guideline implementation materials.
    • Must adhere to the AAP policy “Conflict of Interest and Relationships with Industry and Other Organizations.” 
    Implementation Scientist Selection and Qualifications
    Implementation scientist candidates interested in serving on the CPG subcommittee are solicited by AAP staff through various channels, including COQIPS and its Implementation Committee, the AAP Quality Improvement Innovation Networks (QuIIN), State Chapters of the AAP, Chapter Quality Network (CQN), Education in Quality Improvement for Pediatric Practice (EQIPP), the AAP quality improvement listserv, and the PPI. The CPG Chair and AAP staff will select the most qualified implementation scientist based on the nominations received from this candidate pool. Candidates should be familiar with the CPG development process outlined here and the AAP's policy, “Toward Transparent Clinical Policies,” and must adhere to the AAP policy “Conflict of Interest and Relationships with Industry and Other Organizations.” 

    Candidates who have formal quality improvement and patient safety training (eg, Advanced Training Program at Intermountain Healthcare, Lean Six Sigma course, Institute for Healthcare Improvement (IHI) Training, I2S2 at Cincinnati Children’s, etc) are preferred. Candidates should be experienced in creating quality improvement metrics, drafting quality improvement tools and change concepts, and performing quality improvement projects. The Implementation Scientist will be expected to deliver implementation tools and resources following guideline creation, including specific tools that can be implemented by frontline clinicians to accelerate guideline implementation. These resources may include aim statements, key driver diagrams, chart review tools, patient or provider educational resources, and metrics to evaluate whether changes are resulting in improvements. An example of these resources was developed by the Genetics in Primary Care Institute–Quality Improvement Project.8 When feasible, the full guideline subcommittee will review, make necessary recommendations for improvement, and approve the implementation tools and resources. 
     
    Recommended qualifications for the Implementation Scientist include:

    • Practiced outpatient or inpatient general pediatrics within the past 5 years.
    • Quality improvement project experience.
    • Having worked on a quality improvement project through multiple improvement cycles.
    • Demonstrated ability to implement projects between different practice settings (beyond his or her own practice).
    • Formal quality improvement and patient safety training.
    • Experience with measure creation, including measure portfolios to determine impact of interventions.
    • Must adhere to the AAP policy “Conflict of Interest and Relationships with Industry and Other Organizations.”
    Practicing General Pediatricians Selection and Qualifications
    Each CPG subcommittee must include at least 1 additional general pediatrician other than the Chair or Vice Chair. 

    Qualifications for practicing general pediatricians include:

    • Should be AAP members (FAAPs), and represent the primary audience to whom the guideline’s recommendations are directed.
    • Should have been in active practice in his or her primary specialty within the past 5 years. 
    • Ideally, should have been actively managing patients in the population proposed by the CPG within the past 5 years.
    Content Expert (e.g., Subspecialist) Selection and Qualifications
    AAP staff will contact Chairs of relevant AAP Sections, Councils, and Committees for applicants as content experts on the CPG subcommittee. Too many content experts can bias discussions and suppress participation by other subcommittee members. The total number of content experts must not exceed the number of general pediatricians who are not content experts. Content experts should be familiar with the CPG development process as outlined here and the AAP policy, “Toward Transparent Clinical Policies” and must adhere to the AAP policy, “Conflict of Interest and Relationships with Industry and Other Organizations.” The CPG chair and AAP staff will select content experts for the subcommittee. 

    Family Representative Selection and Qualifications
    Each CPG subcommittee must include a family representative with experience or knowledge of issues that are important to families affected by the condition being addressed. Having a family representative helps to ensure that the guideline will be relevant to families affected by the recommendations and acknowledges family preferences and choices. Family participation can improve transparency of the guideline development process and ensure that the CPG was not developed to serve special interests. The family representative can help guarantee that guideline recommendations and implementation materials are presented in a manner understandable to most families, and act as a safeguard against conflicts of interest. The family representative should not represent the views of any particular organization, should be familiar with the CPG development process as outlined here and the AAP policy, “Toward Transparent Clinical Policies,” and must adhere to the AAP policy, “Conflict of Interest and Relationships with Industry and Other Organizations.”

    Other Stakeholder(s) Selection and Qualifications
    Inclusion of representatives of multidisciplinary stakeholder groups on the subcommittee helps to identify all relevant evidence, encourages support among intended users of the CPG, and helps to address practical issues in implementing the CPG. Other stakeholders may be identified from non-pediatric medical specialties and other health disciplines, including nursing, pharmacy, and other allied health fields relevant to the content of the specific CPG. These individuals will be selected by the CPG Chair with input from AAP staff. Stakeholder members of the subcommittee should be familiar with the CPG development process as outlined here and the AAP policy, “Toward Transparent Clinical Policies” and must adhere to the AAP policy, “Conflict of Interest and Relationships with Industry and Other Organizations.” 

    Guideline Coach Selection and Qualifications
    Upon approval of the guideline topic, nominations will be solicited for a Guideline Coach, and the COGD (with input from AAP staff) will from these nominations recommend a Guideline Coach to the COQIPS Chair. Qualifications of the Guideline Coach include:

    • Must have participated in the development of an AAP clinical practice guideline
    • Should be a Fellow of the American Academy of Pediatrics, and a current AAP member
    • Must be available to participate in subcommittee meetings and conference calls as needed



    AAP Staff Qualifications and Responsibilities
    The AAP staff for the CPG subcommittee has prior experience with the development of clinical practice guidelines, familiarity with literature searches, an understanding of study design and medical terminology, and familiarity with the CPG development process as outlined here and the AAP policy, “Toward Transparent Clinical Policies.”

Responsibilities of All CPG Subcommittee Members

Regardless of position, all members of the CPG subcommittee have the following responsibilities:

  • Full disclosure of any potential conflicts of interest;

  • Participation in all meetings and conference calls;

  • Be committed to teamwork and clear communication; 

  • Read all relevant materials and give constructive feedback;  

  • Be prompt in responding to e-mails relevant to the subcommittee;

  • Meet deadlines in completing assignments;

  • Maintain confidentiality during the development process and until the guideline is published;

  • Submit a signed copy (and retain a personal copy) of the AAP Guideline Confidentiality Agreement; and

  • If representing another organization, communicate promptly and regularly with it to note any concerns about the CPG, and transmit these concerns back to the subcommittee.  

Participation in writing the manuscript of the CPG is not a requirement for subcommittee membership but is decided based on member interest and ability, although all committee members are expected to review the final document. (CPG authors will be identified as distinct from subcommittee members who do not meet authorship criteria. Criteria for authorship are listed here.

Conflict of Interest (COI)

It is important to remember that unmanaged intellectual COIs can be as damaging as unmanaged financial COIs to the quality and credibility of the final guideline product. Intellectual COIs can come into play when content experts (eg, subspecialists) push a view or interpretation of data that they have either developed through clinical trials or other research endeavors and/or upon which they have built their professional reputations. Relevant COIs (eg, financial, industry relationships, intellectual) of the authoring team will be examined before authors are allowed to participate in the guideline committee. If existing conflicts are deemed acceptable, relevant conflicts will be documented in the manuscript.

See AAP policy, “Conflict of Interest and Relationships with Industry and Other Organizations."

Authorship Criteria

The International Committee of Medical Journal Editors recommends that authorship be based on the following 4 criteria: 

  1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND 

  2. Drafting the work or revising it critically for important intellectual content; AND 

  3. Final approval of the version to be published; AND 

  4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. 

Confidentiality

Guideline subcommittee members may in their role be exposed to certain confidential and/or proprietary information, materials or data related to the subcommittee’s work and final document(s). It is important to the integrity of the writing process and final work that this information be kept strictly confidential and not disclosed at any time under any circumstance.  

Therefore, as a condition and in consideration of a member’s selection to serve on the guideline subcommittee, and in recognition of the importance of the subcommittee’s work and for mutual consideration, the receipt and adequacy of which are acknowledged by the parties, guideline subcommittee members agree to the following: 

  • Members will not disclose or cause to be disclosed to anyone or any entity outside of the guideline subcommittee or appropriate AAP staff any confidential and/or proprietary information, materials or data related to the guideline subcommittee’s work, where such information, materials or data have been previously identified in writing or marked by the guideline subcommittee as “Confidential.” This restriction shall apply at any time and in any circumstance, unless otherwise directed by the guideline subcommittee Chair. 

  • Members will keep all such confidential information in their possession or control in a safe and secure place and will take all reasonable steps to protect against inadvertent disclosure or theft of the information. 

  • Upon request from the guideline subcommittee Chair, members will promptly destroy all confidential information received or acquired relating to the guideline subcommittee. Notwithstanding the return or destruction of any such confidential information, members will continue to be bound by their obligations under the Nondisclosure Agreement found here.

Copyright Release and Transfer

In consideration for his or her contributions to the American Academy of Pediatrics (the “Academy”), and for other good and valuable consideration, the receipt of which is hereby acknowledged, guideline subcommittee members grant and assign exclusively to the Academy all right, title, and interest that the member (i.e., author) may now or hereafter own, including copyright and all rights subsumed thereunder, in and to all contributions made by the member (i.e., author) to all publications (“works”) created in the course of his or her appointment/election as a clinical practice guideline subcommittee member/liaison/consultant of their respective guideline. All guideline subcommittee members will be required to sign a copyright release agreement to participate.

External Partnership/Collaborations

When the AAP determines that it would like to proceed with the development of a joint clinical practice guideline with an external organization, AAP staff will work in concert with the guidelines staff at the corresponding entity to draft and develop a memorandum of understanding (MOU). At a minimum, the MOU should include the following:

  • Chair nomination; 

  • A description of the CPG subcommittee representation;

  • Associated costs regarding who will fund the external liaison;

  • Anticipated time commitment;

  • Anticipated title of the clinical practice guideline; 

  • COI disclosure requirements;

  • Copyright/publication rights (the AAP shall be the only entity to publish the joint guideline in full text);

  • Documentation of confidentiality;

  • Peer review considerations; and 

  • Endorsement and approval processes. 

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