Standards documents for our evolving specialty
By Alda Tam, MD, FSIR Fall 2018
The SIR Standards Division has set a goal to ensure it develops documents that are more impactful for the specialty and that will withstand methodological scrutiny given the new standards set by the Institute of Medicine (IOM) in 2011.1
To this end, all standards documents must now meet the IOM’s development requirements:2
- Use a transparent methodology
- Disclose any conflicts of interest
- Be produced by an inclusive, balanced and appropriately trained panel
- Follow a validated and strict evidence-based methodology
- Have recommendations supported by adequate levels of evidence
- Be updated at reasonable intervals
To comply with these requirements, SIR has implemented a new standardized process to develop standards and several other changes that will improve the strength and quality of the documents. This IRQ article is the first in a series that will highlight those changes.
Standards development lifecycle
In designing the new processes, SIR solicited feedback from SIR members, which cited the importance of transparency in:
- Topic selection and prioritization
- JVIR review
- Author selection
- Ways members could contribute
In response to this feedback, the Standards Division developed a document lifecycle (see Fig. 1). Each fall, SIR will issue an open call for topics through multiple SIR communication channels. During this time, members may propose topics that require rapid response or are affected by newly published data. The Standards leadership, in conjunction with the SIR Operations Committee, will assess whether the topics submitted address important areas of practice, patient care and patient outcomes. Topics will be evaluated and prioritized on the basis of how they can help SIR members in their practice to:
- Incorporate quality or
- Address economic issues
- Identify potential areas where research is needed
- Advance the specialty (e.g., reimbursement, medical, legal, quality).
The open call period will begin November–December 2018. Topic submission forms will be available on the Standards page and can be accessed at bit.ly/2wcmfJd.
As a specialty, IR involves both a great breadth and depth of procedures. Standards documents translate best evidence into best practice and promote quality by reducing variation in practice, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective or harmful interventions. SIR is aiming for its standards documents to meet these objectives by continuously refining the document development process. This new method of yearly topic submission allows for representation of all the many aspects of IR and provides members with a greater voice in the development of standards documents.
This is the first in a series of planned articles dedicated to the changes within the SIR Standards Division. Stay tuned for further information in coming months.
- Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Institute of Medicine. Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Press, 2011.
- Tam, A.L. et al. Standards 2.0: Methodology Update. J Vasc Interv Radiol, 2018.
Introducing clinical practice guidelines (CPGs)
The SIR Standards Division is currently developing its first clinical practice guideline (CPG), which will be on the use of inferior vena cava (IVC) filters in the treatment of patients with thromboembolic disease.
CPGs provide recommendations that are intended to optimize patient care and assist physicians in clinical decision-making. They are based on a systematic review of evidence in the literature and an assessment of the benefits and possible drawbacks of different care options. In addition, CPGs cite level of evidence and grading for each recommendation, in accordance with IOM requirements.
The other types of standards documents include:
- Competence and training statements: These statements make recommendations on training and competencies required for a given clinical topic, procedure or therapy. Recommendations are supported by evidence when available and/or by expert consensus.
- Quality improvement standards: These statements combine the recommendations of CPGs (where available) and performance measures to provide guidance on clinical quality improvement in IR practice.
- Position statements: These statements reflect SIR’s opinion concerning areas of evolving clinical practice and/or technologies. Position statements are evidence-based whenever possible but, since the scope usually involves a developing clinical practice or technology, the body of evidence may not be robust. An independent panel of experts, usually multidisciplinary, may be convened to develop the document.
- Reporting standards: These statements define a set of standardized data elements to be used in data collection efforts for describing processes and outcomes of IR procedures. The purpose of reporting standards is to facilitate professional agreement on common vocabulary/definitions and to permit comparison of data across studies or combination of data from studies for further analysis.