Clinical practice guidelines serve as a crucial bridge linking research evidence, clinical practice, and health policy decision-making. However, the guideline domain continues to face persistent challenges, including duplicate guideline development, variable methodological quality, lack of transparent reporting, insufficient implementation and translation, and delayed updates. Focusing solely on "how to develop a high-quality guideline" is no longer sufficient to meet the modern healthcare system's demands for timely, trustworthy, actionable, and dynamically updated recommendations. The emergence of the guideline ecosystem marks a shift in guideline research and practice from a linear development process toward a more systematic governance model. Rooted in the evidence ecosystem, the guideline ecosystem has its own distinct functional positioning, encompassing recommendation formulation, clinical implementation, and life-cycle updating. Looking ahead, China should leverage guideline registries, integrated quality assessment systems, implementation science, dynamic updating mechanisms, and artificial intelligence technologies to promote the transformation of its guideline system from scale expansion to an ecosystem-based model characterized by high quality and sustainability.

This study reviews the core methods and models that have emerged from the development of evidence-based medicine over the past 30 years, including the PICO question model, systematic reviews, grading of evidence quality and strength of recommendations, reporting guidelines, the 5S pyramid of evidence resources, and evidence ecosystem. The above methods and models constitute the theoretical system, promote the progress of evidence-based medicine and provide the internal impetus for its development. The clarification of the core methods and key models of evidence-based medicine will help scholars and researchers fully understand its scientific philosophy, explore its future direction in light of current development trends, achieve its renewal and iteration, and further promote the construction of evidence-based science and the development of multidisciplinary integration.

A comprehensive evaluation of clinical practice guidelines (CPGs) is essential to measure their quality. This study introduces the function and meaning of the systematic review of CPGs and combs the development and current status of guideline appraisal tools. On this basis, we expound the content and characteristics of the Scientific, Transparent, and Applicable Rankings Tool (STAR) for Guidelines in depth, with the hope of providing reference for the improvement of the compressive guideline assessment system and the development of high-quality guidelines in the future.

The registration of the guidelines is not only the initial step in the development process, but also an important part of the quality control of the guidelines. Thus, we analyzed the establishment and evolution of registration systems, the current state of guideline registration platforms, and the use of the Practice guideline REgistration for transPAREncy(PREPARE), with the goal of improving the transparency and quality of guideline development.