© 2005 American Thoracic Society DOI: 10.1165/rcmb.2005-0358ED
A New ATS CommitteeCompeting in the Marketplace of Ideas
a Division of Clinical Research Development and INFORMAtion Translation (INFORMA), Italian National Cancer Institute Regina Elena, Rome, Italy; Department of Clinical Epidemiology During the past 10 years, the American Thoracic Society (ATS) has directed considerable efforts toward optimizing the creation and dissemination of official ATS documents and enhancing the implementation of the clinical and scientific recommendations these documents propose. These efforts have culminated in the ATS Board of Directors' approval of a new committee, the Documents Development and Implementation Committee, and a new editor position, the ATS Documents Editor. The first author (H.J.S.) of this editorial is honored to have been proposed by the search committee and approved by the ATS Board as the inaugural Documents Editor. The Documents Editor serves a collaborative role in coordinating the efforts of the ATS Board of Directors, elected officers, journal editors, assemblies, relevant committees, and staff to manage the development, review, publication, dissemination, and implementation of official ATS documents. Previously, the Documents Coordinator, Dr. Gerard Turino, who will continue to support the document process, ably performed these duties. The increasing complexity of developing and implementing ATS documents, however, has underscored the need to consolidate efforts within this new position and a new committee. THE ROLE OF THE DOCUMENTS EDITOR The duties of the Documents Editor include several specific assignments. The first task will be to work with the ATS President and President-Elect to appoint members to the new ATS Documents Development and Implementation Committee, for which the Documents Editor will serve as chair and Dr. Gerald Turino as vice-chair. This committee will support the Documents Editor and the Board of Directors to optimize the outcomes of the following Document Editor's responsibilities:
LEGACY OF EXISTING AND NEW DOCUMENTS These new efforts build on a long legacy of ATS documents that have contributed greatly to the advancement of respiratory medicine by standardizing techniques (e.g., statements on pulmonary function testing), defining disease (e.g., statements on acute respiratory disease and idiopathic fibrosis), promoting public health (e.g., workshops on lung disease and the environment), and guiding clinical practice (e.g., clinical practice guidelines on community-acquired pneumonia and treatment of tuberculosis) (1, 2). The marketplace of ideas, however, constantly evolves and has become more demanding; future official documents must adhere to higher methodology standards and more innovative implementation techniques for the ATS to continue its rich tradition of advancing science and health. The Documents Editor will serve ATS members by complementing their content expertise with document development and implementation expertise to limit inconsistencies in the methodologic quality and, therefore, promote the effectiveness of our ATS documents. These efforts can only be successful if they assist but do not constrain the talents of our ATS membership at large. The Documents Committee will continue—as a core strength of the ATS documents development process—our "bottom up" approach that capitalizes on the creativity, expertise, and commitment of our members to identify and develop topics for official documents. WHAT THE NEW DOCUMENTS EDITOR AND COMMITTEE SEEK TO ACHIEVE FIRST Although the ATS has provided for nearly a decade methodology resources for guiding the development of official documents (3, 4), considerable gaps exist in the application of these resources to actual document development. In the instance of clinical practice guidelines, for example, some guidelines contain insufficient descriptions of how document authors obtained evidence that formed the basis of their recommendations and lack transparency between recommendations and the supporting evidence. These shortcomings would not always withstand tests of truly evidence-based clinical practice guidelines, which require explicit definitions of the question that the guideline addresses, eligibility criteria for the evidence to be considered, graded recommendations for action, and several other essential elements (5, 6). To achieve adherence to ATS standards for evidence-based documents, the Documents Editor will work with the Board of Directors to refine the methodology for ATS guideline development. The Documents Editor will be guided by the Documents Committee and will report through the ATS Executive Committee to the Board of Directors. THE DOCUMENTS DEVELOPMENT AND IMPLEMENTATION COMMITTEE This committee, comprised of 15 to 20 ATS members with expertise and interests related to document development, will recommend to the Board of Directors policies regarding the development of official ATS documents, serve as liaison with other organizations for joint documents, prepare guiding materials for document developers, manage conflict-of-interest concerns, design implementation strategies for documents, and identify strategies for measuring the impact of documents after their publication. Building on the example of clinical practice guidelines, the committee will devote considerable effort to identifying and establishing a grading system to evaluate the quality of evidence and the strength of recommendations for ATS clinical practice guidelines. Various efforts of diverse organizations and societies to develop grading systems have been underway, but a systematic application of one grading system that allows users to retain understanding while switching from one guideline to another—in particular, on an international level—is long overdue (7). The Documents Editor will work with the Grading of Recommendations Assessment, Evaluation, and Development (GRADE) Working Group, which is an international effort to standardize the grading of evidence and recommendations (8). The Documents Development and Implementation Committee will also assist the ATS in identifying current scientific and health care issues for which documents should be considered. On the horizon will be efforts to develop a standard development and reporting methodology for scientific documents that would derive from work already conducted for randomized trials (i.e., Consolidated Standards of Reporting Trials [CONSORT]) (9), diagnostic testing (i.e., Standards for Reporting of Diagnostic Accuracy [STARD]) (10), and systematic reviews (i.e., Quality of Reporting of Meta-Analyses [QUORUM]) (11). FOCUS ON IMPLEMENTATION Implementation of what documents intend to achieve will be a key interest of the Documents Editor and Committee. The Institute of Medicine's challenge for us to cross the quality chasm represents a call for action to the ATS and healthcare systems in general (12). Effective implementation of evidence-based recommendations represents one bridge across this chasm and depends on clinicians being aware of the recommendations, accepting them, agreeing with them, finding them applicable, and applying them correctly if the resources for the recommendations are available (e.g., a new technology) (13). The science of evidence dissemination and implementation is rapidly evolving (14). We anticipate that the Documents Committee can catalyze increased interest among ATS membership in these new fields of implementing evidence-based practice and translational science. We also plan to promote access to funding from public agencies (e.g., Agency for Healthcare Research and Quality) for support of our larger guideline development projects. These efforts can guide the expertise of ATS members toward becoming more involved in national efforts to implement best clinical practices, improve processes of care, and develop measures of the quality of care delivered. These latter interests become increasingly more important to ATS members as Medicare and third-party payers adopt value-based reimbursement ("pay-for-performance") systems, which depend on measures of quality performance. In addition, specialty boards will incorporate professional society statements to develop their materials and metrics for maintenance of certification. Yet the committee will remind the ATS that people take care of patients and advance science and every patient and circumstance is unique. Evidence alone does not make complex decisions, and unconsidered application of clinical practice guidelines and other recommendations can do more harm than good or prove to be infeasible (15, 16). We look forward to this new ATS endeavor and will welcome feedback from ATS members, our sister societies, and our journal readership regarding the future direction of our official documents. Footnotes Conflict of Interest Statement: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript. References
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