A few years ago, I served as the policy coordinator on the AAP’s Council on Sports Medicine and Fitness (COSMF) executive committee. During that time, I compared the policy development process at the AAP with those of other medical professional organizations, and it was quite clear that the AAP was setting the standard for others to follow. This has not changed. In the current issue of Pediatrics, “Better Guidelines and Policies: AAP’s Partnership for Policy Implementation” describes how the AAP is continuing to improve this process (10.1542/peds.2023-061360). In this article, Dr. Christoph Lehmann, from the University of Texas Southwestern Medical Center, and his co-authors from 9 US institutions and the AAP describe the founding of the Partnership for Policy implementation (PPI) within the AAP. This article and the accompanying video abstract provide a fascinating inside look at the tools and resources that the PPI is using to assure that clinical guidance from the AAP is clear and readily implementable at the point of care.
However, developing high-quality clinical guidance documents is the first step. This information then needs to be disseminated to practicing clinicians, which is often quite challenging. For example, in 2010 the AAP released the 4th edition of the Preparticipation Physical Evaluation (PPE) monograph to a significant amount of fanfare. This publication and supporting documents (e.g., the PPE history and examination forms) reflected AAP policy and was the de facto standard of care for performing PPEs. Many states adopted the recommendations contained within this document for their required PPEs. However, 4 years later, during the AAP’s Peds21 symposium on sports medicine, audience members were asked if they were familiar with these PPE recommendations. My fellow COSMF executive committee members and I were stunned to see that fewer than half of the audience raised their hands! How could this be? This left an impression, and I came to recognize that even the highest quality materials won’t sell themselves. Additional dedicated effort at dissemination and implementation is essential.
As an AAP member and former COSMF policy coordinator, I take pride in the caliber of our academy’s clinical reports and policy statements. They are worth broad distribution and widespread uptake. This article by Lehmann et al. shows that the AAP continues to lead the way in development of high-quality guidance. But the real utility of guidance documents is their ability to influence practice. With the information overload that afflicts many practicing clinicians and the distribution of medical mis- and disinformation, dissemination and uptake of evidence-based information is an even greater challenge than ever before. We need to recognize that publication of policy and clinical guidance documents is not the endpoint but represents a beginning step in improving pediatric care.
(By the way, the 5th edition of AAP’s PPE monograph and evaluation forms are available here.)
