CARI - Caring for Australasians with Renal Impairment - The CARI Guidelines Development Process

The CARI guideline process is undertaken with reference to the levels of evidence currently designated by the NHMRC(Source: NMHRC. How to use the evidence: assessment and application of scientific evidence. Canberra 2000)

Level I: evidence obtained from a systematic review of all relevant RCTs
Level II: evidence obtained from at least one properly designed RCT
Level III: evidence obtained from: well-designed pseudo-randomised controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group
Level IV: evidence obtained from case series, either post-test or pretest/post-test

Flow diagram illustrating the key steps in the CARI Guideline process pdf

Further details of the CARI process is provide in the Guide for Writers pdf

Stages of guideline development

Development of a guideline by the working group occurs in five stages:

Scoping and tasking - identification of sub topics and writing allocation
Literature searching and writing of draft (with assistance from the CARI office)
External peer review, consumer review and nephrology community comment
Steering Committee approval/request for changes to revised draft
Editing and publication of guideline in the journal Nephrology/uploading to CARI and Nephrology websites

How long should this take?

Because there is a need for guidelines to reflect the latest best available evidence, a guideline is never 'finished'. However, the following times can be used as a rough guide.

Time to first draft: approx. 9 months after commencement

Time to finalised draft: approx. 12 months after commencement

Time to publication: approx. 16 months after commencement

Revising Guidelines: this will occur every 3 years. A literature search will be performed by the CARI Office to locate any new trials on each guideline sub topic and the search results will be sent to the relevant guideline writer/s. It is hoped that the Convenors and Members of each Guideline Group will remain the same.

Annual critical appraisal workshops

In order to assist guideline writers and to ensure consistency in appraisal of the evidence base for preparation of the guidelines, the CARI Guideline Office run annual critical appraisal workshops. These one day workshops cover the following areas:

The CARI Guideline process
Critical appraisal of randomised controlled trials
Critical appraisal of systematic reviews
Critical appraisal of diagnostic test studies
Evidence, opinion and CARI recommendations

Where possible workshops are timed to coincide with the first face to face meetings of guideline groups.

Want to contribute?

If you are interested in joining a Guideline Group, please feel free to approach the CARI administrative office in Sydney. Inquiries about the CARI Guidelines development process are most welcome.

About the CARI logo