Medical Decision Making (MDM)
July/August 2011; 31 (4)
Using Models to Make Policy: An Inflection Point?
Med Decis Making July/August 2011 31: 527-529, doi:10.1177/0272989X11412079
The use of models in guidelines making may be reaching a kind of inflection point, based on the evolution of 2 separate—but coincidentally converging—lines of work in the fields of guidelines making and model building. The result will be improved transparency about the differences among guidelines and the reasons for differences. Transparency is particularly important in an age when guidelines for the same problem, made by different organizations, may vary substantially and when the “trustworthiness” or quality of guidelines has been questioned because of weaknesses in the steps by which guidelines are made. Users of guidelines— clinicians, patients, and policy makers—need transparency to make informed choices among guidelines.
Transparency is challenging because of the detail, complexity, and kinds of expertise involved at each of the 3 steps in guidelines making:
– Evidence is gathered systematically, evaluated for quality, and selected on the basis of strength for use in quantitative analysis.
– Analysis of the evidence is conducted quantitatively, often through modeling, to show the likely outcomes of different intervention strategies.
– Using the results of steps 1 and 2, guidelines groups then decide among different strategies, based on the decision makers’ values and decision thresholds.
In 2011, it is increasingly clear what kinds of expertise should be involved in each step and which methods will help ensure trustworthiness. Steps 1 and 2 may in some instances be done by “neutral” groups, expert in clinical research methodology and modeling, whereas groups that actually create guidelines may focus on step 3.
To understand and improve the overall process, the Institute of Medicine (IOM) of the US National Academy of Sciences recently released 2 reports. One, titled “Finding What Works in Health Care: Standards for Systematic Reviews,” is concerned with the quality of step 1, the process used to gather, review, and “weigh” evidence. 1 The …