Improving the use of research evidence in guideline development: 13. Applicability, transferability and adaptation

Schünemann, Holger J; Fretheim, Atle; Oxman, Andrew D

The research evidence on what reflects the best distribution of responsibilities during the development of international guidelines is sparse. Global evidence (i.e. the best evidence from around the world) is the best starting point for judgements about effects and likely modifying factors. Synthesizing and making available this evidence should be coordinated centrally, although the actual work can be done anywhere. For example, the Agency for Health Care and Quality (AHRQ) funds Evidence-based Practice Centres throughout the US and Canada with the methodological competency to undertake systematic reviews, the UK National Institute for Health and Clinical Excellence (NICE) funds National Collaborating Centres responsible for guideline development (in areas such as acute care, cancer and chronic conditions), and the Cochrane Collaboration has 50 Collaborative Review Groups spread around the world that are responsible for preparing and updating systematic reviews (in particular areas such as breast cancer, infectious diseases, and tobacco addiction). WHO could adapt, commission or prepare systematic reviews that are required for guideline development in collaboration with organizations such as these that conduct systematic reviews and follow suggestions to make these reviews more useful for policymakers [36] . Lavis and colleagues suggest that donors and international agencies can encourage more informed public policymaking by supporting national and regional efforts to undertake systematic reviews and assess their local applicability, and by supporting regional or worldwide efforts to coordinate review and assessment processes [37] .