The proposed research seeks to examine the relationship between financial conflicts of interest and recommendations in clinical practice guidelines. This application outlines an approach to describe the current level of industry relationships in an important segment of practice guidelines, specifically those on glycemic control in diabetes. We will examine the impact of industry relationships on the quality and specific recommendations in these practice guidelines.
The specific aims are to: 1) assess the quality of the comparative effectiveness systematic reviews upon which practice guidelines for the pharmacotherapy of glycemic control in diabetes were based;2) determine the quality and robustness of practice guidelines;3) describe the financial relationships with industry among practice guideline sponsors and authors;and 4) examine relationships between industry, guideline authors and sponsors, and guideline recommendations. We will identify all relevant practice guidelines in the National Guidelines Clearinghouse,(tm) obtain the comparative effectiveness reviews upon which each practice guideline was based, and assess the quality of these reviews. The quality of each practice guideline will be assessed and we will independently generate recommendations using the underlying comparative effectiveness reviews for each guideline and an explicit framework. We will then compare the recommendations in the original practice guideline with our recommendations to assess the robustness of each recommendation. The frequency and type of financial relationships with industry for the authors and sponsor of each guideline will be identified, and we will examine the associations between those relationships and the quality and robustness of the practice guidelines. We will then examine the impact of financial relationships with industry on the percentage of pro-industry recommendations. Healthcare providers and patients must trust the information that they are provided with. Conflicts of interest can bias that information, which breaks that trust, decreases the credibility of the research or guidelines, and may ultimately lead to suboptimal patient care or even harm. Understanding the impact of industry relationships will help guideline sponsors to develop appropriate policies for managing conflict of interest.

Public Health Relevance

Many groups produce clinical practice guidelines to help physicians provide the best health care, based on evidence of what works well. If someone involved in preparing these guidelines has a financial relationship with companies that sell medications or equipment related to that healthcare condition, this conflict of interest may interfere with the quality of the guidelines. In this project we will look at different types of conflict of interest, and how these conflicts might affect healthcare recommendations about the control of blood sugar in diabetes.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
1R01HS018500-01
Application #
7785880
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Nix, Mary
Project Start
2009-09-30
Project End
2011-09-29
Budget Start
2009-09-30
Budget End
2010-09-29
Support Year
1
Fiscal Year
2009
Total Cost
Indirect Cost
Name
Oregon Health and Science University
Department
Biostatistics & Other Math Sci
Type
Schools of Medicine
DUNS #
096997515
City
Portland
State
OR
Country
United States
Zip Code
97239
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Holmer, Haley K; Ogden, Lauren A; Burda, Brittany U et al. (2013) Quality of clinical practice guidelines for glycemic control in type 2 diabetes mellitus. PLoS One 8:e58625
Norris, Susan L; Holmer, Haley K; Ogden, Lauren A et al. (2013) Conflicts of interest among authors of clinical practice guidelines for glycemic control in type 2 diabetes mellitus. PLoS One 8:e75284
Norris, Susan L; Holmer, Haley K; Ogden, Lauren A et al. (2012) Conflict of interest disclosures for clinical practice guidelines in the national guideline clearinghouse. PLoS One 7:e47343
Norris, Susan L; Holmer, Haley K; Burda, Brittany U et al. (2012) Conflict of interest policies for organizations producing a large number of clinical practice guidelines. PLoS One 7:e37413
Norris, Susan L; Holmer, Haley K; Ogden, Lauren A et al. (2012) Characteristics of physicians receiving large payments from pharmaceutical companies and the accuracy of their disclosures in publications: an observational study. BMC Med Ethics 13:24
Norris, Susan L; Burda, Brittany U; Holmer, Haley K et al. (2012) Author's specialty and conflicts of interest contribute to conflicting guidelines for screening mammography. J Clin Epidemiol 65:725-33
Burda, Brittany U; Norris, Susan L; Holmer, Haley K et al. (2011) Quality varies across clinical practice guidelines for mammography screening in women aged 40-49 years as assessed by AGREE and AMSTAR instruments. J Clin Epidemiol 64:968-76
Norris, Susan L; Holmer, Haley K; Ogden, Lauren A et al. (2011) Conflict of interest in clinical practice guideline development: a systematic review. PLoS One 6:e25153