Guideline “Implementability” Appraisal or if you write it will they use it?
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Transcript of Guideline “Implementability” Appraisal or if you write it will they use it?
Guideline “Implementability” Appraisal Guideline “Implementability” Appraisal or if you write it will they use it? or if you write it will they use it?
Jean SlutskyJean SlutskyDirector, Center for Outcomes and EvidenceDirector, Center for Outcomes and Evidence
September 4, 2008September 4, 2008
OverviewOverview
DefinitionsDefinitions PitfallsPitfalls SolutionsSolutions ResourcesResources
Implementation vs. Implementation vs. ImplementabilityImplementability
Design and deployment Design and deployment of systems, tools, and of systems, tools, and strategies designed to strategies designed to influence clinicians’ influence clinicians’ behavior toward behavior toward adherence to guideline adherence to guideline recommendationsrecommendations
Measurement: changes Measurement: changes in the structure, in the structure, process, and outcomes process, and outcomes of careof care
Source: Rick ShiffmanSource: Rick Shiffman
Characteristics that Characteristics that predict the relative ease predict the relative ease of implementation of of implementation of guideline knowledgeguideline knowledge
Measurement: ease of Measurement: ease of accuracy of accuracy of transformation of transformation of recommendations of recommendations of systems, tools, and systems, tools, and strategies that influence strategies that influence care; prediction of care; prediction of barriersbarriers
PrecisionPrecision
The tension exists in The tension exists in the uncertainty that the uncertainty that resides in the resides in the swampland known swampland known as the evidence gap as the evidence gap and the need to be and the need to be exact to assist exact to assist implementationimplementation
How do guideline developers How do guideline developers deal with uncertainty?deal with uncertainty?
They unintentionally They unintentionally (or intentionally?) (or intentionally?) make make recommendations that recommendations that are vague or are vague or impreciseimprecise– Periodicity “as Periodicity “as
needed” “routinely” “as needed” “routinely” “as indicated”indicated”
– Importance “as Importance “as appropriate”appropriate”
The consequences of The consequences of imprecisionimprecision
It leads to variability because everyone It leads to variability because everyone decides what “as needed” meansdecides what “as needed” means
Hard to develop organizational systems Hard to develop organizational systems to enhance guideline use when to enhance guideline use when statements are hard to interpretstatements are hard to interpret
It yields the authority of the guideline It yields the authority of the guideline panel to the individual implementerpanel to the individual implementer
The Guideline Implementability The Guideline Implementability Appraisal (GLIA)Appraisal (GLIA)
The objective of GLIA is to provide a tool The objective of GLIA is to provide a tool for the appraisal of the implementability for the appraisal of the implementability of clinical guidelines. of clinical guidelines.
GlobalGlobal– Precisely under what conditions to do Precisely under what conditions to do
something something Decidability Decidability
– Precisely under what conditions to do Precisely under what conditions to do something something
The Guideline Implementability The Guideline Implementability Appraisal (GLIA)Appraisal (GLIA)
Executability Executability – Exactly what to do under the Exactly what to do under the
circumstances defined circumstances defined Effect On Process Of CareEffect On Process Of Care
– Degree to which the recommendation Degree to which the recommendation impacts upon the usual workflow of a care impacts upon the usual workflow of a care setting setting
Presentation & FormattingPresentation & Formatting– Degree to which the recommendation is Degree to which the recommendation is
easily recognizable and succinct easily recognizable and succinct
The Guideline Implementability The Guideline Implementability Appraisal (GLIA)Appraisal (GLIA)
Measurable OutcomesMeasurable Outcomes– Degree to which the guideline identifies Degree to which the guideline identifies
markers or endpoints to track the effects of markers or endpoints to track the effects of implementation of this recommendation implementation of this recommendation
Apparent Validity Apparent Validity – Degree to which the recommendation Degree to which the recommendation
reflects the intent of the developer and the reflects the intent of the developer and the strength of the evidence strength of the evidence
The Guideline Implementability The Guideline Implementability Appraisal (GLIA)Appraisal (GLIA)
Novelty/Innovation Novelty/Innovation – Degree to which the recommendation Degree to which the recommendation
proposes behaviors considered proposes behaviors considered unconventional by clinicians or patients unconventional by clinicians or patients
The Guideline Implementability The Guideline Implementability Appraisal (GLIA)Appraisal (GLIA)
Flexibility Flexibility – Degree to which a recommendation Degree to which a recommendation
permits interpretation and allows for permits interpretation and allows for alternatives in its execution alternatives in its execution
Computability Computability – Ease with which a recommendation can be Ease with which a recommendation can be
operationalized in an electronic information operationalized in an electronic information system system
BMC Medical Informatics and Decision Making 2005, 5:23
http://gem.med.yale.edu/glia/login.htm
ResourcesResources
http://gem.med.yale.edu/cogs/links.dohttp://gem.med.yale.edu/cogs/links.do http://gem.med.yale.edu/glia/login.htmhttp://gem.med.yale.edu/glia/login.htm http://gem.med.yale.edu/default.htmhttp://gem.med.yale.edu/default.htm www.guideline.govwww.guideline.gov www.g-i-n.netwww.g-i-n.net