New methods facilitated the process of prioritizing questions and health outcomes in guideline development

Wojtek Wiercioch, Robby Nieuwlaat, Yuan Zhang, Pablo Alonso-Coello, Philipp Dahm, Alfonso Iorio, Veena Manja, Reem A. Mustafa, Ignacio Neumann, Thomas L. Ortel, Bram Rochwerg, Nancy Santesso, Sara K. Vesely, Elie A. Akl, Holger J. Schünemann


Background: Health guideline development requires sequential prioritization of the guideline topic, questions, and health outcomes. In this paper we report on new approaches for prioritizing questions and outcomes in guidelines. Methods: Ten guideline panels on venous thromboembolism rated potential guideline questions on a 9-point scale according to their overall importance and 6 criteria: common in practice, uncertainty in practice, variation in practice, new evidence available, cost consequences, not previously addressed. We randomized panelists to rate one potential question with and without the 6 criteria. Panelists rated importance of outcomes, defined with health outcome descriptors (HODs), using a 9-point scale, and health utility of outcomes on a visual analogue scale. Results: Of 469 potential questions identified, 72.5% were rated as important but not of high priority, and 25.4% as high priority. Each criterion was significantly associated with the overall importance rating. The overall importance rating means were 5.96 (SD 2.38) and 6.53 (SD 2.45) (P = 0.25) for those randomized to rate questions with and without the criteria, respectively. The mean importance rating for 121 outcomes was 6.01 (SD 1.25), with 35.5% rated as critical for decision-making. Panelists provided health utility ratings for 127 outcomes, with a minimum mean rating of 0.12 (SD 0.10) and maximum of 0.91 (SD 0.15). Conclusion: Our structured process provided information to help explain perspectives of question importance, to facilitate panels’ outcome prioritization, and to facilitate decision-making in guideline development.

Original languageEnglish (US)
Pages (from-to)91-104
Number of pages14
JournalJournal of Clinical Epidemiology
StatePublished - Mar 2022


  • clinical practice guidelines
  • expert panels
  • health outcome importance
  • health outcome utility
  • healthcare question prioritization

ASJC Scopus subject areas

  • Epidemiology


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