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The CNS recognizes that clinical practice guidelines are potentially useful tools for improving the quality of clinical patient care. However, the CNS also asserts that these guidelines must be of the highest possible quality in order to limit the potential for unjustified restriction of provider autonomy and flexibility in the pursuit of optimal clinical care. The CNS agrees with the Institute of Medicine that the highest quality clinical practice parameter guidelines have recommendations supported by adequate levels of evidence; are produced by inclusive, balanced, and appropriately trained panels of clinical practice stakeholders that are multidisciplinary when appropriate; follow a validated and strict evidence based methodology; and are updated at reasonable time intervals.
High quality evidence-based clinical practice parameter guidelines should take precedence over lower quality formal consensus statements and/or appropriateness criteria. As such, formal consensus statements, appropriateness criteria and other clinical directives employing a less rigorous methodology should only be utilized in health policies, regulatory measures, government and third-party payer demonstration projects, and reimbursement policies when up-to-date, high quality, multidisciplinary evidence-linked clinical practice parameter guidelines do not exist for the condition or circumstance in question. Additionally, it is of vital importance that, in the latter setting, sufficient latitude and exception criteria should exist and be codified to allow or clinically indicated flexibility based on relevant subspecialty expertise and/or complex or unusual clinical circumstances.