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How we develop
recommendations

A ‘living evidence’ model that responds rapidly to emerging research while adhering to trusted standards for evidence synthesis and guideline development

1. Set scope

The initial scope of the guidance is:

To provide specific, patient-focused recommendations for the clinical care of people with suspected or confirmed COVID-19, where care for this patient group differs from usual care provided to patients with similar clinical conditions (pneumonia, severe acute respiratory distress, etc.).

We will revise scope as necessary, in discussion with members of the Taskforce and the guideline panels, and with endorsement by the Executive of the Taskforce.

2. Develop questions

We work with a range of stakeholders to ensure that questions in the living guideline are important and relevant for Australian clinicians and consumers.

First, we gather potential new clinical topics and questions using: (a) input and advice from organisational partners of the Taskforce and other stakeholders; (b) suggestions received from clinicians and consumers through our website or via the guideline feedback portal on MAGICApp; and (c) issues raised by our Evidence Review Team.

Then, we screen these topics and questions to determine if they are within the guideline scope (as listed above). Topics and questions that are deemed to be within scope are then prioritised for inclusion by the Guideline Leadership Group and relevant Guideline Panel. Clinical questions are prioritised according to the following criteria:

  1. The likely impact on patient outcomes;
  2. The proportion of the clinical population that is impacted by this issue;
  3. The extent of variation and/or clinical uncertainty in current practice; and
  4. The likelihood of new evidence emerging.

Questions that are considered to be a priority are assigned to the Evidence Review Team to identify and synthesise available evidence. This evidence is then reviewed by the appropriate Guideline Panel.

3. Find evidence

The preliminary recommendations contained within this guideline are based on an analysis of existing national and international guidelines focused on the treatment of adults with COVID-19. These guidelines were sourced by members of the Taskforce and collaborators.

The second stage of the process will involve updating these recommendations using data identified from peer-reviewed primary studies. The search methods are currently being developed to inform this stage, and further information will be provided when this process is finalised. Cochrane is establishing an annotated register of COVID-19 study reports that will include all human studies of COVID-19, focusing initially on interventional, diagnostic and prognostic studies. Once available, the COVID-19 register will become the principal source of relevant research.

4. Synthesise evidence

Where research is available to address our questions, we conduct living systematic reviews as the basis of evidence summaries, and draft evidence-based recommendations following GRADE methods, to be considered and revised by our guideline panels. We may, as the panels agree is appropriate, draw on studies providing indirect evidence from patients with SARS/MERS/pandemic influenza.

5. Convene guideline panels

We have convened multidisciplinary guideline panels to consider the research evidence, review consensus recommendations developed by other guideline groups, and contribute clinical expertise. These panels include clinicians with a range of expertise from a variety of clinical settings across Australia. All panel members complete a declaration of potential conflicts of interest, and absent themselves from discussions related to these potential conflicts.

We have initially convened three guideline panels, addressing patients with mild illness, moderate illness and severe/critical illness.

We will recruit new panel members, and convene further panels, to address particular areas of clinical expertise or need as they arise. Future panel expansion may include policy-maker involvement and consumer representation, and may address population groups with special care requirements, such as children, pregnant women, people who are immunosuppressed and those with comorbid conditions.

6. Draft recommendations

We base recommendations on the best available research evidence (where evidence is available to guide decision-making), the consensus recommendations of guideline groups convened in other jurisdictions, and the expert experience of the guideline panels.

Where possible, these processes follow GRADE methodology, adapted as necessary to be suitable for the expedited nature of the process. Where adaptations to the GRADE methods are made, these are documented and the methods used clearly described.

Guideline panels consider, refine and agree new and revised existing recommendations at weekly meetings.

7. Finalise and publish

New and revised recommendations made by the guideline panels are endorsed by the National Steering Committee of the Taskforce each week.

Endorsed recommendations are published online in MAGICapp each week and disseminated through traditional and social media channels.

Find out more about how to read and interpret the recommendations »

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