How has the methodology evolved from the first edition in 1990 to the current edition? How rigorous is the Care Guidelines^® methodology?

In 1990, the standard method of writing guidelines was consensus-based, using a predominance of expert opinion supplemented by the medical literature. As evidence-based methodologies developed in the 1990s, Milliman Care Guidelines adopted a process that includes:

• Full-time faculty of clinicians, epidemiologists and librarians
• Evidence collection with standardized searches of medical literature
• Analysis of medical literature based on evidence hierarchy and explicit criteria
• Analysis of state, national and proprietary databases for real-world corroboration of research literature
• Outside expert review by independent practicing clinicians
• Formal group process when evidence is inconclusive
• Application of an evidence grade to key guideline recommendations
• Field testing and continual feedback by users
• Annual update and publication of all guideline content