In an article published online July 5 in Annals of Internal Medicine, a framework is presented for the development of living practice guidelines in health care.

Ibrahim K. El Mikati, M.D., from the American University of Beirut in Lebanon, and colleagues established a framework to characterize the processes of development of living practice guidelines in health care. Three background reviews were conducted, after which a core team drafted a first version of the framework. This framework was refined through an online survey and online discussions with a multidisciplinary international group of 51 persons with experience with guidelines.

The authors note that the unit of update in a living guideline is the individual recommendation. The framework addresses several processes and provides definitions. The planning process addresses adoption of the living methodology and each specific guideline project, while the production process includes initiation, maintenance, and retirement phases. Reporting should cover the evidence surveillance time stamp and, when applicable, the outcomes of reassessing evidence and revisiting a recommendation. The dissemination process may require use of different venues, including one suitable for formal publication.

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