Sustainable healthcare - a suite of research projects to reform processes for evidence synthesis and guideline production in order to tackle medical excess

Background: There is now widespread global consensus that medical excess threatens the health of individuals and poses challenges for health system sustainability. Unnecessary tests and treatments bring direct harm to people. Low value care also consumes resources leading to underuse in other areas, thereby indirectly harming patients.

Purpose: To develop methods to address the increasingly important challenge of medical excess in guideline development, in order to mitigate harmful waste within health systems.

Methods: First, we will develop a framework for aspects of medical excess relevant to guideline production, using a Delphi survey method. The framework will then be used to evaluate current guidelines in four research projects.

Gaps in guidelines will be mapped out in order to identify areas where changes to current guideline development frameworks are valuable. Based on the findings, new evidence-based guidance for guideline panels will be developed.

Importance: A newly established collaboration between Cochrane Sustainable Healthcare and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) group will develop new gold standards for evidence synthesis and guideline development.

The impact of these new evidence-based standards will be substantial, given the widespread adoption and utilization of GRADE methods in the guideline development process for professional organizations internationally, including the World Health Organization.