A new approach to medical guidelines, with inspiration from Wikipedia

The “Wikiguideline” approach establishes recommendations only when high-quality, hypothesis-confirming evidence is available.

11:00 AM

Author | Noah Fromson

stethoscope
Michigan Medicine

To improve the process for establishing medical guidelines, a group of international researchers are taking a new approach that leans on online collaboration and high quality data.

The novel "Wikiguideline" takes inspiration from Wikipedia, an open-access encyclopedia in which online collaborators contribute to the creation of reference material. Using osteomyelitis, an infection of the bone, as a test case, researchers from Michigan Medicine joined more than 60 contributors to establish a guideline for management of the condition. The results are published in JAMA Network Open.

"This is an innovative, evidence-based and consensus-driven method that has not been published before in medical literature – one that is relatable and inclusive," said Jaimo Ahn, M.D., Ph.D., FACS, co-author of the paper and an orthopaedic surgeon at University of Michigan Health.

"In practice, the Delphi method assembles a small number of experts who comment and vote. In this Wiki, we use the same systematicity used in the Delphi, but all the methods, evaluation and determination of recommendations are open and transparent to all of the many members of the group. Another important distinction is that in the Delphi method, and others like it, great effort is made to force consensus upon a group, even when group members actually disagree. In contrast, we sought to highlight such disagreements when no high-quality data were available to resolve them."

Researchers came together in June of 2021 and February of the following year to tackle seven questions regarding proper practice for treating osteomyelitis, which is a common cause of illness in hospitalized patients. They found the data sufficient to establish definitive recommendations for only two questions: increasing the adoption of oral antibiotic therapy and limiting the duration of therapy. For the other five questions, researchers say the data available were insufficient to support a clear recommendation. 

The traditional framework for developing clinical practice guidelines is the GRADE system, in which individuals grade the quality of evidence before applying it to a specific outcome. Ahn says using this system would have resulted in recommendations even with lower quality of evidence.

"This Wiki method is remarkable for many reasons – it would also allow clinical guidelines to be more up-to-date," said Shiwei Zhou, M.D., co-author of the paper and an infectious disease physician at U-M Health. "And it acknowledges the uncertainty behind many expert recommendations."

The next step for the research group is to tackle other important clinical questions where an inclusive, expert-driven yet evidence-based and systematic approach would be helpful.

"If you have a problem and expertise, perhaps you might be a part of the next solution," Ahn said.

Paper cited: "Use of Novel Strategies to Develop Guidelines for Management of Pyogenic Osteomyelitis in Adults," JAMA Network Open. DOI: 10.1001/jamanetworkopen.2022.11321


More Articles About: Lab Notes Orthopaedic Surgery Infection Control Health Care Delivery, Policy and Economics Health Care Quality Bones and Muscles and Joints (Orthopaedics)
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of health care news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories woman sitting at table in stripe shirt stressed seeming white background window
Health Lab
An unequal toll of financial stress
Inflation rates may have cooled off recently, but a poll shows many older adults are experiencing financial stress – especially those who say they’re in fair or poor physical health or mental health
woman laying down and sheet over going into surgery
Health Lab
Older women more likely to receive heart surgery, die at low quality hospitals
Women over the age of 65 who require complex heart surgery are more likely than men to receive care at low quality hospitals — where they also die in greater numbers following the procedure, a Michigan Medicine study finds.
sunscreen blue people outside
Health Lab
Sunscreen dispensers make skin cancer prevention easier
Medical students have worked to place dispensers at parks, pools and golf courses around Washtenaw County to give people easy access to sunscreen.
people standing in teal background with bubbles overhead
Health Lab
What can America do to make health care and health outcomes more equal?
Inequality in health care access and delivery, and in health outcomes, have changed somewhat in the past 20 years but more needs to be done to reduce racial and ethnic disparities.
pills spilling out of bottle
Health Lab
Primary care physicians are hesitant to accept chronic pain patients using opioids or cannabis
Michigan Medicine research finds that patients with chronic pain who use either substance may find it harder to find primary care physician than those who don’t.
Woman Patient Preparing Surgery Anesthesia
Health Lab
Female heart patients less likely to have additional problems fixed during surgery
Two studies led by Michigan Medicine find that female patients who undergo heart surgery are less likely to have secondary ailments corrected during a procedure — despite guidelines that indicate they should.