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