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The ACR publishes multiple types of documents to provide guidance for its members, but some potentially beneficial topics have not fit neatly into existing production pathways. To answer the need, the ACR has formed a Guidance Subcommittee to the Quality of Care (QOC) Committee. This will allow the ACR to adapt more nimbly, when appropriate, to the informational needs of the rheumatology community.
Previously Existing Publication Pathways
The ACR publishes different kinds of helpful written materials, such as those geared to patient education. The ACR also provides a variety of guidance documents, some of which give clinical information to help inform care. Until now, most ACR-endorsed guidance documents have fallen into one of three categories: clinical practice guidelines, position statements and white papers.
Clinical practice guidelines—with development overseen by the QOC Committee—are rigorously developed documents using codified processes, including systematic literature reviews, GRADE methodology, disclosure and conflict of interest evaluations and a formal peer review process. Guidelines typically require 18–24 months to complete.
The QOC Committee chair is Sindhu Johnson, MD, PhD, an associate professor in the Division of Rheumatology at the University of Toronto, Ontario, Canada. “Position papers are generally consensus driven, with some reference to published data. The intent of these papers is mainly advocacy, for example, to payers and government,” she explains. White papers frame issues and provide information about current data on a particular topic, but generally include few or no direct recommendations.
Dr. Johnson
“Over the last few years, members of the rheumatology community have made a number of requests to evaluate or develop products that really don’t fit into any of those aforementioned types of documents,” Dr. Johnson says. For example, a document providing clinical information and recommendations may need to be produced more quickly than a traditional clinical practice guideline, or a topic may be too narrow for this purpose, requiring review of a smaller body of medical literature than a standard clinical practice guideline.
In February 2020, the ACR Board of Directors created the new Guidance Subcommittee, overseen by the QOC, to play a role in the development and potential endorsement of alternative types of documents that may provide helpful clinical recommendations. For ultimate ACR endorsement, a given document will need to be approved by the Guidance Subcommittee, then by the QOC and, ultimately, by the ACR Board of Directors.
The specifics of this involvement will vary by the situation. For example, the Guidance Subcommittee will provide feedback to outside groups that want to consult with the ACR to maximize the chance of creating a document that will ultimately achieve ACR endorsement. Other times, it may play no role in document creation but may decide whether to approve a submitted document and send it on for approval by the QOC.
The Guidance Subcommittee is also tasked with identifying topics that may be suited to these alternative types of guidance documents. In all cases, the Guidance Subcommittee will decide whether a document can be sent on to the QOC for potential ACR endorsement.
