The New Guidance Subcommittee Gives ACR More Document Flexibility

Criteria for Document Approval

Dr. FitzGerald

The chair of the Guidance Subcommittee is John D. FitzGerald, MD, PhD, clinical chief of the Division of Rheumatology at the David Geffen School of Medicine at the University of California, Los Angeles. He says, “Our group seeks to provide feedback to authors to ensure that appropriate methodology has been applied and clearly described. We try to guide authors through the approval process by the QOC, Board and ultimate review by the journals.”

To help accomplish this, the subcommittee is using specific criteria to help evaluate potential projects and their resulting guidance documents. Documents should address timely topics of high interest to the rheumatology community. Those ultimately approved by the Guidance Subcommittee must include a description of the evidence review and synthesis, and details on the expert-based consensus method used.

Dr. Johnson notes, “These [document] projects do not need to be as rigorous as the formal guideline process, but we expect a minimum standard of rigor to support the recommendation, and ideally, it should be a balance of published data, if available, and expert consensus.” She adds that a certain amount of flexibility is purposefully built into the process, for example in the types of methodologies that could be used, to help accommodate the specific needs of a given project.

For approval, documents must also outline how conflicts of interest would be or were disclosed and managed. Last, all approved guidance documents must be consistent with the overarching values of the ACR.

The Guidance Subcommittee can provide feedback to those creating the document, which hopefully allows it to move forward through the review and approval process. Although the ultimate goal is for most documents to achieve endorsement by the ACR and potential publication in a journal, the subcommittee will also provide input if a given project may be better suited to a different format.

Future Guidance Documents

The Guidance Subcommittee is currently evaluating proposed documents brought forward by ACR members and others that might ultimately achieve ACR endorsement, but it has not weighed in on any guidance documents that are now available.

However, Dr. FitzGerald notes the ACR has already released excellent examples of the type of document the subcommittee may approve or help create in the future: the guidance documents created on the management of adult and pediatric patients during the COVID‑19 pandemic. These were written by an ad hoc committee formed at about the same time as the subcommittee, which hadn’t yet established its procedures.

“The ACR was responding to providers’ and patients’ needs to hear more about COVID‑19,” Dr. FitzGerald says. “The COVID-19 clinical guidance papers were providing timely guidance on a new topic; they were important. They were not [clinical practice] guideline documents, but they do have clinical recommendations in there, so they are a good example of the kind of documents the Guidance Subcommittee would now do.” The first published guidance document managed by the subcommittee is expected to provide clinical recommendations related to COVID-19 vaccines.

More information about the Guidance Subcommittee can be found on the ACR website.