American Academy of Dermatology (AAD) guideline development follows an established methodology and administrative regulations that include a rigorous review and grading of the relevant scientific literature, input of an expert volunteer physician work group, and a multi-layer peer review approval process.
Oversight of these efforts is the responsibility of the Clinical Guidelines Committee (CGC). The Academy continually evaluates and, if necessary, modifies its development processes to respond to new challenges in an effort to produce timely and informative guidance for its members while maintaining an integral evidence-based structure.
The AAD is mindful of the potential for conflict of interest (COI) to influence guideline content and has developed a COI policy specific to those who participate in the development process.
Below is a brief summary of the steps in the AAD guideline development process:
1. Identify and select guideline topics: Guideline topics are identified through a needs assessment process involving input from representatives of several Academy councils, committees, and task forces. AAD members are encouraged to submit guideline topics for consideration. Evaluation and prioritization of topics is facilitated by review of several criteria:
- Degree of public health importance (high prevalence, significant morbidity).
- Perceived or documented variation in practice patterns.
- Potential for performance measure and MOC module development.
- Timeliness of topic for informing and improving provider decision making.
- Availability and strength/quality of evidence to produce clinical recommendations.
- Area addresses multiple aspects of dermatology practice scope
- An area in which increased dermatologic attention and involvement would be helpful for the specialty.
- Relevancy to Medicare and Medicaid programs.
- Relevancy to managed care programs.
- Availability of interventions with high societal or economic cost.
2. Identify experts and form work groups: Once a guideline topic has been approved by the board, the work group chair(s) and members are identified and appointed after a thorough consideration of clinical expertise and potential conflict of interest. Academy members who wish to serve on a guideline work group may submit their names for consideration.
3. Determine guideline scope and clinical questions for literature Review: Academy guidelines may be developed in one of three possible scopes (broad, targeted, or narrow) depending on the selected topic, and may address one or more clinical questions. These questions serve as the basis for the literature retrieval and critical review of identified publications.
4.Develop clinical recommendations and guideline text: The best available evidence to be used in support of clinical recommendations is graded using the SORT scale, allowing for the strength/quality of the evidence and the strength of the recommendation to be determined. These recommendations facilitate the drafting of supporting guideline text.
5. Review, comment, and approval process: Once the work group has completed and approved a draft guideline, it moves on to an extensive review, comment, and approval process, which includes the following:
- Clinical Guidelines Committee (CGC).
- AAD Members.
- Council on Science and Research.
- Board of Directors.
At each stage, solicited feedback is considered for incorporation into the guideline, or revision of the guideline, as supported by the available evidence and expert clinical judgment of the work group. This review process also is used to screen for any potential conflict of interest. Approvals from the CGRC and Council on Science and Research are required prior to submission of the draft guideline to the board of directors.
6. JAAD publication: Following approval of the guideline by the board, the text is submitted to JAAD for publication consideration, where it follows the JAAD manuscript review process for acceptance.
7. Periodic review: Guidelines are reaffirmed, updated, or sunset at least every five years based on a review of new evidence that could affect the guideline's recommendations.