1
|
Roberts V, Carter P, Barnett P, Mugglestone MA, Pilling S. Committee experiences of using formal consensus in healthcare guidelines: a longitudinal qualitative study. BMC Med Inform Decis Mak 2023; 23:147. [PMID: 37533013 PMCID: PMC10398942 DOI: 10.1186/s12911-023-02220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND This feasibility study has the primary aim of capturing and comparing participant expectations and experiences of using a formal consensus method (FCM) and to explore whether these views change following participation within a guideline committee where FCM are used. METHODS Twelve healthcare committee members and associated technical team members participated in semi-structured qualitative interviews before and after using FCM during guideline committee meetings. Interviews also focused on past experiences and expectations of informal consensus methods. RESULTS Participants said formal consensus included a greater range of evidence. They described positive reactions and found it a useful way to encourage involvement by balancing group power dynamics. Group discussion time was identified as important to clarify ideas, supported by good group chairing. However, participants reported that undertaking FCM required additional resources and suggested targeting its use for low quality evidence, limited committee expertise, or where the evidence is controversial. CONCLUSIONS FCM is an acceptable alternative to informal consensus methods that has qualities specifically helpful to healthcare guidelines such as encouraging participation, inclusivity of a broad range of evidence, and managing group dynamics. More research is required to better understand when using formal consensus is most appropriate and effective.
Collapse
Affiliation(s)
- V Roberts
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Patrice Carter
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK.
| | - P Barnett
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - M A Mugglestone
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK
| | - S Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK
| |
Collapse
|
2
|
Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: Clinical Practice Guideline Methods. J Orthop Sports Phys Ther 2022; 52:665-674. [PMID: 35881706 DOI: 10.2519/jospt.2022.11307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES: To present the methods used to develop a clinical practice guideline (CPG) with recommendations endorsed by key stakeholders for assessing, managing, and supporting return to work for adults with rotator cuff disorders. DESIGN: Clinical practice guideline development. METHODS: A steering committee composed of the research team of this project led the development of this CPG in 5 phases, which followed the standards of the NICE and AGREE II collaborations. During the preparation phase (I), a multidisciplinary working committee of experts in managing rotator cuff disorders (n = 20) determined the scope and objectives of the CPG. The recommendations development phase (II) included initial knowledge synthesis, development of preliminary recommendations, systematic consultations with a multidisciplinary panel of key stakeholders (n = 51) using a modified three-round Delphi approach and drafting of the original CPG. In the external evaluation phase (III), an external committee of experts evaluated the original CPG using the AGREE II tool. In the dissemination phase (IV), the strategy for disseminating the CPG was developed and implemented. During the update phase (V), the CPG was revised based on an update of the initial knowledge synthesis. RESULTS: Seventy-three preliminary recommendations were developed from the initial knowledge synthesis. During the Delphi consultation, all of these recommendations were endorsed, and one new recommendation was proposed by panelists. The original CPG received an overall AGREE II score of 83% from the external evaluators. In 2021, an update of the initial 2017 knowledge synthesis was conducted and 13 recommendations were revised. CONCLUSION: The 5-phase consensus methods approach guided the development of a high-quality CPG on assessing, managing, and supporting return to work for adults with rotator cuff disorders. J Orthop Sports Phys Ther 2022;52(10):665-674. Epub: 27 July 2022. doi:10.2519/jospt.2022.11307.
Collapse
|
3
|
Zeng L, Yi Q, Huang L, Chen W, Men P, Zhang J, Jiang Z, Miao L, Zhao R, Zhang X, Zhang L. The guideline for therapeutic drug monitoring guidelines development. J Evid Based Med 2022; 15:272-283. [PMID: 36178674 DOI: 10.1111/jebm.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/27/2022] [Indexed: 01/11/2023]
Abstract
AIM The guideline is meant to standardize the principles, procedures, and methods for developing therapeutic drug monitoring (TDM) guidelines and promoting open, transparent, scientific, and credible TDM guidelines. METHODS Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society established guideline working groups, declared and managed conflicts of interest. The guideline working groups used the Delphi method to formulate the purpose and scope of the guidelines and questions in the PICO format, searched and synthesized evidence, and integrated with the current situation in China and TDM characteristics to preliminarily develop recommendations for the guideline for TDM guideline development in China. Through internal discussions of the guideline working groups and external peer review, the content was improved, and we eventually formulated a guideline suitable for guiding TDM-related guidelines. RESULTS The guideline provides suggestions for problems to be identified and solved in the planning, development, publishing, and updating stages of TDM guidelines, including forming guideline working groups, planning guidelines, declaration and management of interests, formulating questions and selecting outcomes, preparing the planning proposal, evidence retrieval and synthesis, evidence assessment, developing recommendations, drafting guidelines, external review guidelines, publishing and disseminating guidelines, postevaluation of guidelines, and updating guidelines. CONCLUSIONS This guideline can provide methodological guidance and reference for the development of TDM guidelines.
Collapse
Affiliation(s)
- Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P.R. China
| | - Qiusha Yi
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P.R. China
| | - Liang Huang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P.R. China
| | - Wenqian Chen
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Peng Men
- Department of Pharmacy, Peking University Third Hospital, Beijing, P.R. China
| | - Jingjing Zhang
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Zhimei Jiang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P.R. China
| | - Liyan Miao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, P.R. China
| | - Xianglin Zhang
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P.R. China
| |
Collapse
|
4
|
Goossen K, Becker M, Mathes T, Follmann M, Holtkamp U, Hostettler S, Meerpohl JJ, Nothacker M, Schaefer C, Schmidt S, Schünemann HJ, Sommer I, Tholen R, Skoetz N, Pieper D. [German-language translation of the PANELVIEW instrument to evaluate the guideline development process from the perspective of the guideline group]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 168:106-112. [PMID: 35078748 DOI: 10.1016/j.zefq.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The development process for clinical guidelines is influenced by factors that are relevant to the validity of a guideline but often are not captured sufficiently in the final guideline documents. PANELVIEW is an English-language tool that can be used to explore the guideline development process from the perspective of guideline group members. Our aim was to translate the PANELVIEW tool into German, taking into account national contexts and linguistic differences. METHODS The PANELVIEW tool was initially translated by a core team, then refined and approved by a group of experts in a consensus-based Delphi process. The experts were selected on the basis of their experience in guideline development covering different fields (clinical, methodological, organisational, health professional, patient perspective) and geographical regions (Germany, Austria, Switzerland). A representative of the original PANELVIEW team was also involved. The Delphi steps included an online survey, an online consensus conference and final approval by circulating the results via email. Individual items were seen as generally agreed upon if the level of agreement in the respective steps was 75 % or more. RESULTS The expert group consisted of 12 persons. Of these, 11 (92 %) participated in the online survey and 10 (83 %) in the subsequent consensus conference. After the first Delphi step, sufficient agreement was achieved for 19 of 34 items (56 %). The remaining 15 items were discussed in the consensus conference and finally obtained 100 % agreement. The discussion focused on clarifying and adapting terms whose meaning was ambiguous or inadequate in the German context, which led to a deviation from the original wording in some instances. DISCUSSION The PANELVIEW tool was translated into German by means of a Delphi process. PANELVIEW complements existing instruments for assessing the methodological quality of guidelines by capturing the perspective of the guideline group. This will enable guideline developers and organisations to identify problems in the drafting process and avoid them in future projects. User testing and validation of the German-language PANELVIEW tool are planned for the future. CONCLUSION The German-language translation of PANELVIEW will enable guideline developers in German-speaking countries to continuously evaluate and, where necessary, improve the process and methods of guideline development.
Collapse
Affiliation(s)
- Käthe Goossen
- Abteilung für evidenzbasierte Versorgungsforschung, Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland.
| | - Monika Becker
- Abteilung für evidenzbasierte Versorgungsforschung, Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
| | - Tim Mathes
- Abteilung für evidenzbasierte Versorgungsforschung, Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
| | | | | | | | - Joerg J Meerpohl
- Institut für Evidenz in der Medizin, Universitätsklinikum & Medizinische Fakultät, Universität Freiburg & Cochrane Deutschland Stiftung, Freiburg, Deutschland
| | - Monika Nothacker
- AWMF Institut für Medizinisches Wissensmanagement, c/o Philipps Universität Marburg/AWMF Berlin, Deutschland
| | - Corinna Schaefer
- Ärztliches Zentrum für Qualität in der Medizin, Berlin, Deutschland
| | - Stefanie Schmidt
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland
| | - Holger J Schünemann
- Michael G DeGroote Cochrane Canada and McMaster GRADE centres; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Kanada
| | - Isolde Sommer
- Donau-Universität Krems, Department für Evidenzbasierte Medizin und Evaluation, Krems, Österreich
| | - Rheina Tholen
- Deutscher Verband für Physiotherapie (ZVK) e.v., Kompetenzzentrum Wissenschaft, Forschung, Aus-, Fort- und Weiterbildung, Köln, Deutschland
| | - Nicole Skoetz
- Evidenz-basierte Onkologie, Klinik I für Innere Medizin, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln, Deutschland
| | - Dawid Pieper
- Abteilung für evidenzbasierte Versorgungsforschung, Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
| |
Collapse
|
5
|
Li SA, Yousefi-Nooraie R, Guyatt G, Talwar G, Wang Q, Zhu Y, Hozo I, Djulbegovic B. A few panel members dominated guideline development meeting discussions: Social network analysis. J Clin Epidemiol 2021; 141:1-10. [PMID: 34555427 DOI: 10.1016/j.jclinepi.2021.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/05/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify patterns of interactions that may influence guideline panels' decision-making. STUDY DESIGN AND SETTING Social network analysis (SNA) to describe the conversation network in a guideline development meeting in United States. RESULTS We analyzed one two-day guideline panel meeting that included 20 members who developed a guideline using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. The conversation pattern of the guideline panel indicated a well-connected network (density=0.59, clustering coefficient=0.82). GRADE topics on quality of evidence and benefits versus harms accounted for 46%; non-GRADE factors accounted for 30% of discussion. The chair, co-chair and methodologist initiated 53% and received 60% of all communications in the meeting; 42% of their communications occurred among themselves. SNA metrics (eigenvector, betweenness and closeness) indicated that these individuals also exerted highest influence on discussion, controlled information flow and were at the center of all communications. Members were more likely to continue previous discussion with the same individuals after both morning breaks (r=0.54, P<0.005; r=0.17, P=0.04), and after the last break on day 2 (r=0.44, P=0.015). CONCLUSION Non-GRADE factors such as breaks, and the members' roles, affect guideline development more than previously recognized. Collectively, the chair, co-chair and methodologist dominated the discussion.
Collapse
Affiliation(s)
- Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada.
| | | | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Gaurav Talwar
- Michael G DeGroote School of Medicine, McMaster University, Ontario, Canada
| | - Qi Wang
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Ying Zhu
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Iztok Hozo
- Department of Mathematics, Indiana University, IN, USA
| | - Benjamin Djulbegovic
- Department of Computational & Quantitative Medicine, Beckman Research Institute, City of Hope, Duarte, CA, USA
| |
Collapse
|
6
|
Bodnar LM, Khodyakov D, Parisi SM, Himes KP, Burke JG, Hutcheon JA. Rating the seriousness of maternal and child health outcomes linked with pregnancy weight gain. Paediatr Perinat Epidemiol 2021; 35:459-468. [PMID: 33216402 PMCID: PMC8134513 DOI: 10.1111/ppe.12741] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/18/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current pregnancy weight gain guidelines were developed based on implicit assumptions of a small group of experts about the relative seriousness of adverse health outcomes. Therefore, they will not necessarily reflect the values of women. OBJECTIVE To estimate the seriousness of 11 maternal and child health outcomes that have been consistently associated with pregnancy weight gain by engaging patients and health professionals. METHODS We collected data using an online panel approach with a modified Delphi structure. We selected a purposeful sample of maternal and child health professionals (n = 84) and women who were pregnant or recently postpartum (patients) (n = 82) in the United States as panellists. We conducted three concurrent panels: professionals only, patients only, and patients and professionals. During a 3-round online modified Delphi process, participants rated the seriousness of health outcomes (Round 1), reviewed and discussed the initial results (Round 2), and revised their original ratings (Round 3). Panellists assigned seriousness ratings (0, [not serious] to 100 [most serious]) for infant death, stillbirth, preterm birth, gestational diabetes, preeclampsia, small-for-gestational-age (SGA) birth, large-for-gestational-age (LGA) birth, unplanned caesarean delivery, maternal obesity, childhood obesity, and maternal metabolic syndrome. RESULTS Each panel individually came to a consensus on all seriousness ratings. The final median seriousness ratings combined across all panels were highest for infant death (100), stillbirth (95), preterm birth (80), and preeclampsia (80). Obesity in children, metabolic syndrome in women, obesity in women, and gestational diabetes had median seriousness ratings ranging from 55 to 65. The lowest seriousness ratings were for SGA birth, LGA birth, and unplanned caesarean delivery (30-40). CONCLUSION Professionals and women rate some adverse outcomes as being more serious than others. These ratings can be used to establish the range of pregnancy weight gain associated with the lowest risk of a broad range of maternal and child health outcomes.
Collapse
Affiliation(s)
- Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States,Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Sara M. Parisi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Katherine P. Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jessica G. Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer A. Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
7
|
Wiercioch W, Akl EA, Santesso N, Zhang Y, Morgan RL, Yepes-Nuñez JJ, Kowalski S, Baldeh T, Mustafa RA, Laisaar KT, Raid U, Etxeandia-Ikobaltzeta I, Carrasco-Labra A, Ventresca M, Neumann I, Falavigna M, Brignardello-Petersen R, Morgano GP, Brożek J, McConnell M, Schünemann HJ. Assessing the process and outcome of the development of practice guidelines and recommendations: PANELVIEW instrument development. CMAJ 2021; 192:E1138-E1145. [PMID: 33020121 DOI: 10.1503/cmaj.200193] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Guideline recommendations may be affected by flaws in the process, inappropriate panel member selection or conduct, conflicts of interest and other factors. To our knowledge, no validated tool exists to evaluate guideline development from the perspective of those directly involved in the process. Our objective was to develop and validate a universal tool, the PANELVIEW instrument, to assess guideline processes, methods and outcomes from the perspective of the participating guideline panellists and group members. METHODS We performed a systematic literature search and surveys of guideline groups (identified through contacting international organizations and convenience sampling of working panels) to inform item generation. Subsequent groups of guideline methodologists and panellists reviewed items for face validity and missing items. We used surveys, interviews and expert review for item reduction and phrasing. For reliability assessment and feedback, we tested the PANELVIEW tool in 8 international guideline groups. RESULTS We surveyed 62 members from 13 guideline panels, contacted 19 organizations and reviewed 20 source documents to generate items. Fifty-three additional key informants provided feedback about phrasing of the items and response options. We reduced the number of items from 95 to 34 across domains that included administration, training, conflict of interest, group dynamics, chairing, evidence synthesis, formulating recommendations and publication. The tool takes about 10 minutes to complete and showed acceptable measurement properties. INTERPRETATION The PANELVIEW instrument fills a gap by enabling guideline organizations to involve clinicians, patients and other participants in evaluating their guideline processes. The tool can inform quality improvement of existing or new guideline programs, focusing on insight into and transparency of the guideline development process, methods and outcomes.
Collapse
Affiliation(s)
- Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Juan José Yepes-Nuñez
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Sérgio Kowalski
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Tejan Baldeh
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Kaja-Triin Laisaar
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Ulla Raid
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Itziar Etxeandia-Ikobaltzeta
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Alonso Carrasco-Labra
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Matthew Ventresca
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Ignacio Neumann
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Maicon Falavigna
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Jan Brożek
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Meghan McConnell
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact (Wiercioch, Akl, Santesso, Zhang, Morgan, Baldeh, Mustafa, Etxeandia-Ikobaltzeta, Carrasco-Labra, Ventresca, Brignardello-Petersen, Morgano, Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; School of Medicine (Yepes-Nuñez), Universidad de los Andes, Bogotá, Colombia; Department of Internal Medicine (Kowalski), Federal University of Paraná, Curitiba, Brazil; Division of Nephrology and Hypertension (Mustafa), Department of Medicine, University of Kansas Medical Center, Kansas City, Kan.; Guideline Development Group (Laisaar), Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Ministry of Social Affairs (Raid), Tallinn, Estonia; Department of Internal Medicine (Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Federal University of Rio Grande do Sul (Falavigna), Institute for Health Technology Assessment, Porto Alegre, Brazil; Department of Medicine (Brożek, Schünemann), McMaster University, Hamilton, Ont.; Department of Innovation in Medical Education (McConnell), University of Ottawa, Ottawa, Ont.
| | | |
Collapse
|
8
|
Zia A, Kouides P, Khodyakov D, Dao E, Lavin M, Kadir RA, Othman M, Bauman D, Halimeh S, Winikoff R, Revel-Vilk S. Standardizing care to manage bleeding disorders in adolescents with heavy menses-A joint project from the ISTH pediatric/neonatal and women's health SSCs. J Thromb Haemost 2020; 18:2759-2774. [PMID: 32573942 DOI: 10.1111/jth.14974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bleeding disorders (BD) are under-recognized in adolescents with heavy menstrual bleeding (HMB). OBJECTIVES The lack of clinical guidelines and variable symptomatic management of HMB created the imperative to standardize HMB care to identify and manage BD in adolescents. METHODS We convened an international working group (WG), utilized the results of a literature review to define knowledge gaps in HMB care, and used the collective clinical experience of the WG to develop care considerations for adolescents with BD and HMB. We then solicited input on the appropriateness of HMB care considerations from expert stakeholders representing hematology, adolescent medicine, and obstetrics-gynecology. We conducted an expert panel online, using the ExpertLens platform. During a three-round online modified-Delphi process, the expert panel rated the appropriateness of 21 care considerations using a 9-point scale to designate care as appropriate (7-9), uncertain (4-6), or inappropriate (1-3) covering screening for BD, the laboratory work-up, and management of adolescents with BD that present with HMB. We used the RAND/UCLA appropriateness method to determine the existence of consensus among the interdisciplinary panel of experts. RESULTS Thirty-nine experts participated in the panel. The experts rated fifteen HMB care considerations as appropriate, six as uncertain, and none as inappropriate. CONCLUSIONS The HMB care statements represent the first set of HMB care considerations in adolescents with BD, developed with broad expert input on appropriateness. Although likely to be of interest to a range of clinicians who routinely manage adolescents with HMB, additional research is required in many key areas.
Collapse
Affiliation(s)
- Ayesha Zia
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Pediatric Hematology Oncology, Children's Health, Dallas, TX, USA
| | - Peter Kouides
- The University of Rochester and the Mary M. Gooley Hemophilia Treatment Center, Rochester, NY, USA
| | | | - Emily Dao
- RAND Corporation, Santa Monica, CA, USA
| | - Michelle Lavin
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rezan Abdul Kadir
- The Royal Free Foundation Hospital and Institute for Women's Health, University College, London, UK
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, Queen's University Kingston, School of Baccalaureate Nursing, St Lawrence College Kingston, Kingston, ON, Canada
| | - Dvora Bauman
- Department of Pediatric and Adolescent Gynecology, Hadassah University Medical Center, Jerusalem, Israel
| | - Susan Halimeh
- Medical Thrombosis and Haemophilia Treatment Center, Duisburg, Germany
| | - Rochelle Winikoff
- Division of Hematology-Oncology, Sainte-Justine University Health Center, Montréal, Canada
| | - Shoshana Revel-Vilk
- Pediatric Hematology/Oncology Unit, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel
| |
Collapse
|
9
|
Tetreault L, Nater A, Garwood P, Badhiwala JH, Wilson JR, Fehlings MG. Development and Implementation of Clinical Practice Guidelines: An Update and Synthesis of the Literature With a Focus in Application to Spinal Conditions. Global Spine J 2019; 9:53S-64S. [PMID: 31157146 PMCID: PMC6512193 DOI: 10.1177/2192568219831689] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Review. OBJECTIVES The objectives of this review are to (a) summarize the role of clinical practice guidelines (CPGs), (b) outline the methodology involved in formulating CPGs, (c) provide an illustration of these principles using a CPG developed for degenerative cervical myelopathy, and (d) highlight the importance of knowledge translation. METHODS A review of the literature was conducted to summarize current standards in CPG development and implementation. RESULTS CPGs are systematically developed statements intended to affect decisions made by health care providers, policy makers, and patients. The main objectives of CPGs are to synthesize and translate evidence into recommendations, optimize patient outcomes, standardize care, and facilitate shared decision making among physicians, patients, and their caregivers. The main steps involved in the development of CPGs include defining the clinical problem, assembling a multidisciplinary guideline development group and systematic review team, conducting a systematic review of the literature, translating the evidence to recommendations, critically appraising the CPG and updating the document when new studies arise. The final step in developing a CPG is to implement it into clinical practice; this step requires an assessment of the barriers to implementation and the formulation of effective dissemination strategies. CONCLUSION CPGs are an important component in the teaching and practice of medicine and are available for a wide spectrum of diseases. CPGs, however, can only be used to influence clinical practice if the recommendations are informed by a systematic review of the literature and developed using rigorous methodology. The opportunity to transform clinical management of spinal conditions is an attractive outcome of the application of high-quality CPGs.
Collapse
Affiliation(s)
- Lindsay Tetreault
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University College Cork, Cork, Ireland
| | - Anick Nater
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Jetan H. Badhiwala
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Michael G. Fehlings
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Richter Sundberg L, Garvare R, Nyström ME. Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare. BMC Health Serv Res 2017; 17:344. [PMID: 28490325 PMCID: PMC5426017 DOI: 10.1186/s12913-017-2277-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease. Methods A qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data. Results The guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: ‘clinical knowledge and experience’, ‘potential guideline consequences’ and ‘needs of vulnerable groups’. The frequency of the use of various criteria in discussions varied over time. Gender, professional status, and interpersonal skills were perceived to affect individuals’ relative influence on group discussions. Conclusions The study shows that guideline development groups make compromises between rigour and pragmatism. The formal guideline development model incorporated multiple aspects, but offered few details on how the different criteria should be handled. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from clarifying the role of the group-related factors and non-research evidence, such as clinical experience and ethical considerations, in decision-processes during guideline development.
Collapse
Affiliation(s)
- Linda Richter Sundberg
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87, Umeå, Sweden. .,Department of Clinical Science, Child and Adolescent Psychiatry, Umeå University, SE 901 87, Umeå, Sweden.
| | - Rickard Garvare
- Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, SE 971 87, Luleå, Sweden
| | - Monica Elisabeth Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87, Umeå, Sweden.,Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden
| |
Collapse
|
11
|
Chen E, Budescu DV, Lakshmikanth SK, Mellers BA, Tetlock PE. Validating the Contribution-Weighted Model: Robustness and Cost-Benefit Analyses. DECISION ANALYSIS 2016. [DOI: 10.1287/deca.2016.0329] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
12
|
Mannion R, Freeman T, Millar R, Davies H. Effective board governance of safe care: a (theoretically underpinned) cross-sectioned examination of the breadth and depth of relationships through national quantitative surveys and in-depth qualitative case studies. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundRecent high-profile reports into serious failings in the quality of hospital care in the NHS raise concerns over the ability of trust boards to discharge their duties effectively.ObjectivesOur study aimed to generate theoretically grounded empirical evidence on the associations between board governance, patient safety processes and patient-centred outcomes. The specific aims were as follows: (1) to identify the types of governance activities undertaken by hospital trust boards in the English NHS with regard to ensuring safe care in their organisation; (2) in foundation trusts, to explore the role of boards and boards of governors with regards to the oversight of patient safety in their organisation; (3) to assess the association between particular hospital trust board oversight activities and patient safety processes and clinical outcomes; (4) to identify the facilitators and barriers to developing effective hospital trust board governance of safe care; and (5) to assess the impact of external commissioning arrangements and incentives on hospital trust board oversight of patient safety.MethodsThe study comprised three distinct but interlocking strands: (1) a narrative systematic review in order to describe, interpret and synthesise key findings and debates concerning board oversight of patient safety; (2) in-depth mixed-methods case studies in four organisations to assess the impact of hospital board governance and external incentives on patient safety processes and outcomes; and (3) two national surveys exploring board management in NHS acute and specialist hospital trusts in England, and relating board characteristics to whole-organisation outcomes.ResultsA very high proportion of trust boards reported the kinds of desirable characteristics and board-related processes that research says may be associated with higher performance. Our analysis of the symbolic aspects of board activities highlights the role and differences in local processes of organising the governance of patient safety. Most boards do allocate a considerable amount of time to discussing patient safety and quality-related issues and were using a wide range of hard performance metrics and soft intelligence to monitor its organisation with regard to patient safety. Although the board of governors is generally perceived to be well-meaning, they were also considered to be being largely ineffective in helping to promote and deliver safer care for their organisations. We did not find any statistically significant relationship between board attributes (self-reported) and processes and any patient safety outcome measures. However, we did find a significant relationship between two dimensions of the Board Self-Assessment Questionnaire and two specific-and-related national staff survey organisational ‘process’ measures: (1) staff feeling safe to raise concerns about errors, near-misses and incidents and (2) staff feeling confident that their organisation would address their concerns, if raised. We also found that contracting and external financial incentives appeared to play only a relatively minor role in incentivising quality and safety improvement.ConclusionsOur research is the first large-scale mixed-methods study of hospital board activity and behaviour related to the oversight of patient safety in the English NHS and the key findings should be used to influence the design of future governance arrangements as well as the training and support of board. Our finding that board governance/competencies appear to be linked to staff feeling safe to raise concerns about patient safety issues, and also their confidence that their organisation would address their concern, is worthy of further and more sustained exploration, particularly in the context of the current focus on improving whistleblowing policies in the NHS.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Tim Freeman
- Business School, University of Middlesex, London, UK
| | - Ross Millar
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Huw Davies
- School of Management, University of St Andrews, St Andrews, UK
| |
Collapse
|
13
|
Stellefson M, Alber J, Paige S, Castro D, Singh B. Evaluating Comparative Effectiveness Research Priorities for Care Coordination in Chronic Obstructive Pulmonary Disease: A Community-Based eDelphi Study. JMIR Res Protoc 2015; 4:e103. [PMID: 26268741 PMCID: PMC4705015 DOI: 10.2196/resprot.4591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/30/2015] [Accepted: 07/19/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite research supporting the use of care coordination in chronic obstructive pulmonary disease (COPD), there is relatively little known about the comparative effectiveness of different strategies used to organize care for patients. To investigate the most important COPD care coordination strategies, community-based stakeholder input is needed, especially from medically underserved populations. Web-based platforms are electronic tools now being used to bring together individuals from underrepresented populations to share input and obtain clarification on comparative effectiveness research (CER) ideas, questions, and hypotheses. OBJECTIVE Use low computer-literate, collaborative survey technology to evaluate stakeholder priorities for CER in COPD care coordination. METHODS A mixed-method, concurrent triangulation design was used to collect survey data from a virtual advisory board of community-based stakeholders including medically underserved patients with COPD, informal caregivers, clinicians, and research scientists. The eDelphi method was used to conduct 3 iterative rounds of Web-based surveys. In the first 2 survey rounds, panelists viewed a series of "mini research prospectus" YouTube video presentations and rated their level of agreement with the importance of 10 COPD care coordination topics using 7-point Likert scales. In the final third-round survey, panelists ranked (1=most important, 8=least important) and commented on 8 remaining topics that panelists favored most throughout the first 2 survey rounds. Following the third-round survey, panelists were asked to provide feedback on the potential impact of a Web-based stakeholder engagement network dedicated to improving CER in COPD. RESULTS Thirty-seven panelists rated the following care coordination topics as most important (lower means indicate greater importance): (1) measurement of quality of care (mean 2.73, SD 1.95); (2) management of COPD with other chronic health issues (mean 2.92, SD 1.67); (3) pulmonary rehabilitation as a model for care (mean 3.72; SD 1.93); (4) quality of care coordination (mean 4.12, SD 2.41); and (5) comprehensive COPD patient education (mean 4.27, SD 2.38). Stakeholder comments on the relative importance of these care coordination topics primarily addressed the importance of comparing strategies for COPD symptom management and evaluating new methods for patient-provider communication. Approximately one half of the virtual panel assembled indicated that a Web-based stakeholder engagement network could enable more online community meetings (n=19/37, 51%) and facilitate more opportunities to suggest, comment on, and vote for new CER ideas in COPD (n=18/37, 49%). CONCLUSIONS Members of this unique virtual advisory board engaged in a structured Web-based communication process that identified the most important community-specific COPD care coordination research topics and questions. Findings from this study support the need for more CER that evaluates quality of care measures used to assess the delivery of treatments and interventions among medically underserved patients with COPD.
Collapse
Affiliation(s)
- Michael Stellefson
- Center for Digital Health and Wellness, Department of Health Education and Behavior, University of Florida, Gainesville, FL, United States.
| | | | | | | | | |
Collapse
|
14
|
Semenic S, Edwards N, Premji S, Olson J, Williams B, Montgomery P. Decision-making and evidence use during the process of prenatal record review in Canada: a multiphase qualitative study. BMC Pregnancy Childbirth 2015; 15:78. [PMID: 25881034 PMCID: PMC4389923 DOI: 10.1186/s12884-015-0503-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 03/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prenatal records are potentially powerful tools for the translation of best-practice evidence into routine prenatal care. Although all jurisdictions in Canada use standardized prenatal records to guide care and provide data for health surveillance, their content related to risk factors such as maternal smoking and alcohol use varies widely. Literature is lacking on how prenatal records are developed or updated to integrate research evidence. This multiphase project aimed to identify key contextual factors influencing decision-making and evidence use among Canadian prenatal record committees (PRCs), and formulate recommendations for the prenatal record review process in Canada. METHODS Phase 1 comprised key informant interviews with PRC leaders across 10 Canadian jurisdictions. Phase 2, was a qualitative comparative case study of PRC factors influencing evidence-use and decision-making in five selected jurisdictions. Interview data were analysed using qualitative content analysis. Phase 3 involved a dissemination workshop with key stakeholders to review and refine recommendations derived from Phases 1 and 2. RESULTS Prenatal record review processes differed considerably across Canadian jurisdictions. PRC decision-making was complex, revealing the competing functions of the prenatal record as a clinical guide, documentation tool and data source. Internal contextual factors influencing evidence use included PRC resources to conduct evidence reviews; group composition and dynamics; perceived function of the prenatal record; and expert opinions. External contextual factors included concerns about user buy-in; health system capacities; and pressures from public health stakeholders. Our recommendations highlight the need for: broader stakeholder involvement and explicit use of decision-support strategies to support the revision process; a national template of evidence-informed changes that can be used across jurisdictions; consideration of both clinical and surveillance functions of the prenatal record; and dissemination plans to communicate prenatal record modifications. CONCLUSIONS Decision-making related to prenatal record content involves a negotiated effort to balance research evidence with the needs and preferences of prenatal care providers, health system capacities as well as population health priorities. The development of a national template for prenatal records would reduce unnecessary duplication of PRC work and enhance the consistency of prenatal care delivery and perinatal surveillance data across Canada.
Collapse
Affiliation(s)
- Sonia Semenic
- School of Nursing, McGill University, 3506 University Street, Montreal, Quebec, H3A 2A7, Canada.
| | - Nancy Edwards
- University of Ottawa, 1 Stewart Street, Ottawa, Ontario, K1N 6 N5, Canada.
| | - Shahirose Premji
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1 N4, Canada.
- Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Dr. NW, Calgary, AB, Canada.
| | - Joanne Olson
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada.
| | - Beverly Williams
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada.
| | - Phyllis Montgomery
- School of Nursing, Laurentian University, Ramsey Lake Road, Sudbury, Ontario, P3E 2C6, Canada.
| |
Collapse
|
15
|
Kaufmann CP, Stämpfli D, Hersberger KE, Lampert ML. Determination of risk factors for drug-related problems: a multidisciplinary triangulation process. BMJ Open 2015; 5:e006376. [PMID: 25795686 PMCID: PMC4368979 DOI: 10.1136/bmjopen-2014-006376] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Drug-related problems (DRPs) constitute a frequent safety issue among hospitalised patients leading to patient harm and increased healthcare costs. Because many DRPs are preventable, the specific risk factors that facilitate their occurrence are of considerable interest. The objective of our study was to assess risk factors for the occurrence of DRPs with the intention to identify patients at risk for DRPs to guide and target preventive measures where they are needed most in patients. DESIGN Triangulation process using a mixed methods approach. METHODS We conducted an expert panel, using the nominal group technique (NGT) and a qualitative analysis, to gather risk factors for DRPs. The expert panel consisted of two consultant hospital physicians (internal medicine and geriatrics), one emergency physician, one independent general practitioner, one clinical pharmacologist, one clinical pharmacist, one registered nurse, one home care nurse and two independent community pharmacists. The literature was searched for additional risk factors. Gathered factors from the literature search and the NGT were assembled and validated in a two-round Delphi questionnaire. RESULTS The NGT resulted in the identification of 33 items with 13 additional risk factors from the qualitative analysis of the discussion. The literature search delivered another 39 risk factors. The 85 risk factors were refined to produce 42 statements for the Delphi online questionnaire. Of these, 27 risk factors were judged to be 'important' or 'rather important'. CONCLUSIONS The gathered risk factors may help to characterise and identify patients at risk for DRPs and may enable clinical pharmacists to guide and target preventive measures in order to limit the occurrence of DRPs. As a further step, these risk factors will serve as the basis for a screening tool to identify patients at risk for DRPs.
Collapse
Affiliation(s)
- Carole P Kaufmann
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
- Clinical Pharmacy, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Dominik Stämpfli
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Markus L Lampert
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
- Clinical Pharmacy, Kantonsspital Baselland, Bruderholz, Switzerland
| |
Collapse
|
16
|
Mannion R, Thompson C. Systematic biases in group decision-making: implications for patient safety. Int J Qual Health Care 2014; 26:606-12. [PMID: 25320152 DOI: 10.1093/intqhc/mzu083] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Key decisions in modern health care systems are often made by groups of people rather than lone individuals. However, group decision-making can be imperfect and result in organizational and clinical errors which may harm patients-a fact highlighted graphically in recent (and historical) health scandals and inquiries such as the recent report by Sir Robert Francis into the serious failures in patient care and safety at Mid Staffordshire Hospitals NHS Trust in the English NHS. In this article, we draw on theories from organization studies and decision science to explore the ways in which patient safety may be undermined or threatened in health care contexts as a result of four systematic biases arising from group decision-making: 'groupthink', 'social loafing', 'group polarization' and 'escalation of commitment'. For each group bias, we describe its antecedents, illustrate how it can impair group decisions with regard to patient safety, outline a range of possible remedial organizational strategies that can be used to attenuate the potential for adverse consequences and look forward at the emerging research agenda in this important but hitherto neglected area of patient safety research.
Collapse
Affiliation(s)
- Russell Mannion
- Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Rd, Birmingham B15 2RT, UK
| | - Carl Thompson
- Department of Health Sciences, University of York, Area 4, Seebohm Rowntree Building, York YO10 5DD, UK
| |
Collapse
|
17
|
Den Breejen EME, Hilbink MAHW, Nelen WLDM, Wiersma TJ, Burgers JS, Kremer JAM, Hermens RPMG. A patient-centered network approach to multidisciplinary-guideline development: a process evaluation. Implement Sci 2014; 9:68. [PMID: 24898160 PMCID: PMC4087268 DOI: 10.1186/1748-5908-9-68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 04/11/2014] [Indexed: 11/26/2022] Open
Abstract
Background Guideline development and uptake are still suboptimal; they focus on clinical aspects of diseases rather than on improving the integration of care. We used a patient-centered network approach to develop five harmonized guidelines (one multidisciplinary and four monodisciplinary) around clinical pathways in fertility care. We assessed the feasibility of this approach with a detailed process evaluation of the guideline development, professionals’ experiences, and time invested. Methods The network structure comprised the centrally located patients and the steering committee; a multidisciplinary guideline development group (gynecologists, physicians, urologists, clinical embryologists, clinical chemists, a medical psychologist, an occupational physician, and two patient representatives); and four monodisciplinary guideline development groups. The guideline development addressed patient-centered, organizational, and medical-technical key questions derived from interviews with patients and professionals. These questions were elaborated and distributed among the groups. We evaluated the project performance, participants’ perceptions of the approach, and the time needed, including time for analysis of secondary sources, interviews with eight key figures, and a written questionnaire survey among 35 participants. Results Within 20 months, this approach helped us develop a multidisciplinary guideline for treating infertility and four related monodisciplinary guidelines for general infertility, unexplained infertility, male infertility, and semen analysis. The multidisciplinary guideline included recommendations for the main medical-technical matters and for organizational and patient-centered issues in clinical care pathways. The project was carried out as planned except for minor modifications and three extra consensus meetings. The participants were enthusiastic about the approach, the respect for autonomy, the project coordinator’s role, and patient involvement. Suggestions for improvement included timely communication about guideline formats, the timeline, participants’ responsibilities, and employing a librarian and more support staff. The 35 participants spent 4497 hours in total on this project. Conclusions The novel patient-centered network approach is feasible for simultaneously and collaboratively developing a harmonized set of multidisciplinary and monodisciplinary guidelines around clinical care pathways for patients with fertility problems. Further research is needed to compare the efficacy of this approach with more traditional approaches.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
| |
Collapse
|
18
|
Siering U, Eikermann M, Hausner E, Hoffmann-Eßer W, Neugebauer EA. Appraisal tools for clinical practice guidelines: a systematic review. PLoS One 2013; 8:e82915. [PMID: 24349397 PMCID: PMC3857289 DOI: 10.1371/journal.pone.0082915] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/29/2013] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Clinical practice guidelines can improve healthcare processes and patient outcomes, but are often of low quality. Guideline appraisal tools aim to help potential guideline users in assessing guideline quality. We conducted a systematic review of publications describing guideline appraisal tools in order to identify and compare existing tools. METHODS Among others we searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from 1995 to May 2011 for relevant primary and secondary publications. We also handsearched the reference lists of relevant publications. On the basis of the available literature we firstly generated 34 items to be used in the comparison of appraisal tools and grouped them into thirteen quality dimensions. We then extracted formal characteristics as well as questions and statements of the appraisal tools and assigned them to the items. RESULTS We identified 40 different appraisal tools. They covered between three and thirteen of the thirteen possible quality dimensions and between three and 29 of the possible 34 items. The main focus of the appraisal tools were the quality dimensions "evaluation of evidence" (mentioned in 35 tools; 88%), "presentation of guideline content" (34 tools; 85%), "transferability" (33 tools; 83%), "independence" (32 tools; 80%), "scope" (30 tools; 75%), and "information retrieval" (29 tools; 73%). The quality dimensions "consideration of different perspectives" and "dissemination, implementation and evaluation of the guideline" were covered by only twenty (50%) and eighteen tools (45%) respectively. CONCLUSIONS Most guideline appraisal tools assess whether the literature search and the evaluation, synthesis and presentation of the evidence in guidelines follow the principles of evidence-based medicine. Although conflicts of interest and norms and values of guideline developers, as well as patient involvement, affect the trustworthiness of guidelines, they are currently insufficiently considered. Greater focus should be placed on these issues in the further development of guideline appraisal tools.
Collapse
Affiliation(s)
- Ulrich Siering
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Michaela Eikermann
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Elke Hausner
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | | | - Edmund A. Neugebauer
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| |
Collapse
|
19
|
Bosch M, Tavender E, Bragge P, Gruen R, Green S. How to define 'best practice' for use in Knowledge Translation research: a practical, stepped and interactive process. J Eval Clin Pract 2013; 19:763-8. [PMID: 22487019 DOI: 10.1111/j.1365-2753.2012.01835.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Defining 'best practice' is one of the first and crucial steps in any Knowledge Translation (KT) research project. Without a sound understanding of what exactly should happen in practice, it is impossible to measure the extent of existing gaps between 'desired' and 'actual' care, set implementation goals, and monitor performance. The aim of this paper is to present a practical, stepped and interactive process to develop best practice recommendations that are actionable, locally applicable and in line with the best available research-based evidence, with a view to adapt these into process measures (quality indicators) for KT research purposes. METHODS Our process encompasses the following steps: (1) identify current, high-quality clinical practice guidelines (CPGs) and extract recommendations; (2) select strong recommendations in key clinical management areas; (3) update evidence and create evidence overviews; (4) discuss evidence and produce agreed 'evidence statements'; (5) discuss the relevance of the evidence with local stakeholders; and (6) develop locally applicable actionable best practice recommendations, suitable for use as the basis of quality indicators. CONCLUSIONS Actionable definitions of local best practice are a prerequisite for doing KT research. As substantial resources go into rigorously synthesizing evidence and developing CPGs, it is important to make best use of such available resources. We developed a process for efficiently developing locally applicable actionable best practice recommendations from existing high-quality CPGs that are in line with current research evidence.
Collapse
Affiliation(s)
- Marije Bosch
- Research Fellow Senior Research Fellow Professor of Surgery & Public Health, Director, National Trauma Research Institute/Central Clinical School, Monash University, Melbourne, Australia Professorial fellow, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | | |
Collapse
|
20
|
Heselmans A, Aertgeerts B, Donceel P, Van de Velde S, Vanbrabant P, Ramaekers D. Human computation as a new method for evidence-based knowledge transfer in Web-based guideline development groups: proof of concept randomized controlled trial. J Med Internet Res 2013; 15:e8. [PMID: 23328663 PMCID: PMC3636290 DOI: 10.2196/jmir.2055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 07/13/2012] [Accepted: 09/23/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Guideline developers use different consensus methods to develop evidence-based clinical practice guidelines. Previous research suggests that existing guideline development techniques are subject to methodological problems and are logistically demanding. Guideline developers welcome new methods that facilitate a methodologically sound decision-making process. Systems that aggregate knowledge while participants play a game are one class of human computation applications. Researchers have already proven that these games with a purpose are effective in building common sense knowledge databases. OBJECTIVE We aimed to evaluate the feasibility of a new consensus method based on human computation techniques compared to an informal face-to-face consensus method. METHODS We set up a randomized design to study 2 different methods for guideline development within a group of advanced students completing a master of nursing and obstetrics. Students who participated in the trial were enrolled in an evidence-based health care course. We compared the Web-based method of human-based computation (HC) with an informal face-to-face consensus method (IC). We used 4 clinical scenarios of lower back pain as the subject of the consensus process. These scenarios concerned the following topics: (1) medical imaging, (2) therapeutic options, (3) drugs use, and (4) sick leave. Outcomes were expressed as the amount of group (dis)agreement and the concordance of answers with clinical evidence. We estimated within-group and between-group effect sizes by calculating Cohen's d. We calculated within-group effect sizes as the absolute difference between the outcome value at round 3 and the baseline outcome value, divided by the pooled standard deviation. We calculated between-group effect sizes as the absolute difference between the mean change in outcome value across rounds in HC and the mean change in outcome value across rounds in IC, divided by the pooled standard deviation. We analyzed statistical significance of within-group changes between round 1 and round 3 using the Wilcoxon signed rank test. We assessed the differences between the HC and IC groups using Mann-Whitney U tests. We used a Bonferroni adjusted alpha level of .025 in all statistical tests. We performed a thematic analysis to explore participants' arguments during group discussion. Participants completed a satisfaction survey at the end of the consensus process. RESULTS Of the 135 students completing a master of nursing and obstetrics, 120 participated in the experiment. We formed 8 HC groups (n=64) and 7 IC groups (n=56). The between-group comparison demonstrated that the human computation groups obtained a greater improvement in evidence scores compared to the IC groups, although the difference was not statistically significant. The between-group effect size was 0.56 (P=.30) for the medical imaging scenario, 0.07 (P=.97) for the therapeutic options scenario, and 0.89 (P=.11) for the drug use scenario. We found no significant differences in improvement in the degree of agreement between HC and IC groups. Between-group comparisons revealed that the HC groups showed greater improvement in degree of agreement for the medical imaging scenario (d=0.46, P=.37) and the drug use scenario (d=0.31, P=.59). Very few evidence arguments (6%) were quoted during informal group discussions. CONCLUSIONS Overall, the use of the IC method was appropriate as long as the evidence supported participants' beliefs or usual practice, or when the availability of the evidence was sparse. However, when some controversy about the evidence existed, the HC method outperformed the IC method. The findings of our study illustrate the importance of the choice of the consensus method in guideline development. Human computation could be an acceptable methodology for guideline development specifically for scenarios in which the evidence shows no resonance with participants' beliefs. Future research is needed to confirm the results of this study and to establish practical significance in a controlled setting of multidisciplinary guideline panels during real-life guideline development.
Collapse
Affiliation(s)
- Annemie Heselmans
- School of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|
21
|
Ilowite NT, Sandborg CI, Feldman BM, Grom A, Schanberg LE, Giannini EH, Wallace CA, Schneider R, Kenney K, Gottlieb B, Hashkes PJ, Imundo L, Kimura Y, Lang B, Miller M, Milojevic D, O’Neil KM, Punaro M, Ruth N, Singer NG, Vehe RK, Verbsky J, Woodward A, Zemel L. Algorithm development for corticosteroid management in systemic juvenile idiopathic arthritis trial using consensus methodology. Pediatr Rheumatol Online J 2012; 10:31. [PMID: 22931206 PMCID: PMC3520770 DOI: 10.1186/1546-0096-10-31] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of background corticosteroid therapy in rheumatology clinical trials poses a major challenge. We describe the consensus methodology used to design an algorithm to standardize changes in corticosteroid dosing during the Randomized Placebo Phase Study of Rilonacept in Systemic Juvenile Idiopathic Arthritis Trial (RAPPORT). METHODS The 20 RAPPORT site principal investigators (PIs) and 4 topic specialists constituted an expert panel that participated in the consensus process. The panel used a modified Delphi Method consisting of an on-line questionnaire, followed by a one day face-to-face consensus conference. Consensus was defined as ≥ 75% agreement. For items deemed essential but when consensus on critical values was not achieved, simple majority vote drove the final decision. RESULTS The panel identified criteria for initiating or increasing corticosteroids. These included the presence or development of anemia, myocarditis, pericarditis, pleuritis, peritonitis, and either complete or incomplete macrophage activation syndrome (MAS). The panel also identified criteria for tapering corticosteroids which included absence of fever for ≥ 3 days in the previous week, absence of poor physical functioning, and seven laboratory criteria. A tapering schedule was also defined. CONCLUSION The expert panel established consensus regarding corticosteroid management and an algorithm for steroid dosing that was well accepted and used by RAPPORT investigators. Developed specifically for the RAPPORT trial, further study of the algorithm is needed before recommendation for more general clinical use.
Collapse
Affiliation(s)
- Norman T Ilowite
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | - Brian M Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CA
| | - Alexi Grom
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Rayfel Schneider
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CA
| | - Kathleen Kenney
- Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Beth Gottlieb
- Steven and Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA
| | - Philip J Hashkes
- Cleveland Clinic Lerner Medical School, Cleveland, OH, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Lisa Imundo
- Children’s Hospital of New York, New York, NY, USA
| | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Bianca Lang
- IWK Health Center, Dalhousie University, Halifax, NS, USA
| | | | - Diana Milojevic
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Kathleen M O’Neil
- University of Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | | | - Natasha Ruth
- Medical University of South Carolina, Charleston, SC, USA
| | - Nora G Singer
- University Hospitals/Case Medical Center, Cleveland, OH, USA
| | | | | | - Amy Woodward
- Vanderbilt University Medical Center, Indianapolis, IN, USA
| | - Lawrence Zemel
- Connecticut Children’s Medical Center, Hartford, CT, USA
| |
Collapse
|
22
|
Eccles MP, Grimshaw JM, Shekelle P, Schünemann HJ, Woolf S. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest. Implement Sci 2012; 7:60. [PMID: 22762776 PMCID: PMC3523009 DOI: 10.1186/1748-5908-7-60] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 07/04/2012] [Indexed: 11/30/2022] Open
Abstract
Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.
Collapse
Affiliation(s)
- Martin P Eccles
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | | | | | | | | |
Collapse
|
23
|
Khodyakov D, Hempel S, Rubenstein L, Shekelle P, Foy R, Salem-Schatz S, O'Neill S, Danz M, Dalal S. Conducting online expert panels: a feasibility and experimental replicability study. BMC Med Res Methodol 2011; 11:174. [PMID: 22196011 PMCID: PMC3313865 DOI: 10.1186/1471-2288-11-174] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 12/23/2011] [Indexed: 01/10/2023] Open
Abstract
Background This paper has two goals. First, we explore the feasibility of conducting online expert panels to facilitate consensus finding among a large number of geographically distributed stakeholders. Second, we test the replicability of panel findings across four panels of different size. Method We engaged 119 panelists in an iterative process to identify definitional features of Continuous Quality Improvement (CQI). We conducted four parallel online panels of different size through three one-week phases by using the RAND's ExpertLens process. In Phase I, participants rated potentially definitional CQI features. In Phase II, they discussed rating results online, using asynchronous, anonymous discussion boards. In Phase III, panelists re-rated Phase I features and reported on their experiences as participants. Results 66% of invited experts participated in all three phases. 62% of Phase I participants contributed to Phase II discussions and 87% of them completed Phase III. Panel disagreement, measured by the mean absolute deviation from the median (MAD-M), decreased after group feedback and discussion in 36 out of 43 judgments about CQI features. Agreement between the four panels after Phase III was fair (four-way kappa = 0.36); they agreed on the status of five out of eleven CQI features. Results of the post-completion survey suggest that participants were generally satisfied with the online process. Compared to participants in smaller panels, those in larger panels were more likely to agree that they had debated each others' view points. Conclusion It is feasible to conduct online expert panels intended to facilitate consensus finding among geographically distributed participants. The online approach may be practical for engaging large and diverse groups of stakeholders around a range of health services research topics and can help conduct multiple parallel panels to test for the reproducibility of panel conclusions.
Collapse
Affiliation(s)
- Dmitry Khodyakov
- The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Gupta S, Wan FT, Newton D, Bhattacharyya OK, Chignell MH, Straus SE. WikiBuild: a new online collaboration process for multistakeholder tool development and consensus building. J Med Internet Res 2011; 13:e108. [PMID: 22155694 PMCID: PMC3278094 DOI: 10.2196/jmir.1833] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 07/09/2011] [Accepted: 07/09/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Production of media such as patient education tools requires methods that can integrate multiple stakeholder perspectives. Existing consensus techniques are poorly suited to design of visual media, can be expensive and logistically demanding, and are subject to caveats arising from group dynamics such as participant hierarchies. OBJECTIVE Our objective was to develop a method that enables multistakeholder tool building while averting these difficulties. METHODS We developed a wiki-inspired method and tested this through the collaborative design of an asthma action plan (AAP). In the development stage, we developed the Web-based tool by (1) establishing AAP content and format options, (2) building a Web-based application capable of representing each content and format permutation, (3) testing this tool among stakeholders, and (4) revising this tool based on stakeholder feedback. In the wiki stage, groups of participants used the revised tool in three separate 1-week "wiki" periods during which each group collaboratively authored an AAP by making multiple online selections. RESULTS In the development stage, we recruited 16 participants (9/16 male) (4 pulmonologists, 4 primary care physicians, 3 certified asthma educators, and 5 patients) for system testing. The mean System Usability Scale (SUS) score for the tool used in testing was 72.2 (SD 10.2). In the wiki stage, we recruited 41 participants (15/41 male) (9 pulmonologists, 6 primary care physicians, 5 certified asthma educators, and 21 patients) from diverse locations. The mean SUS score for the revised tool was 75.9 (SD 19.6). Users made 872, 466, and 599 successful changes to the AAP in weeks 1, 2, and 3, respectively. The site was used actively for a mean of 32.0 hours per week, of which 3.1 hours per week (9.7%) constituted synchronous multiuser use (2-4 users at the same time). Participants averaged 23 (SD 33) minutes of login time and made 7.7 (SD 15) changes to the AAP per day. Among participants, 28/35 (80%) were satisfied with the final AAP, and only 3/34 (9%) perceived interstakeholder group hierarchies. CONCLUSION Use of a wiki-inspired method allowed for effective collaborative design of content and format aspects of an AAP while minimizing logistical requirements, maximizing geographical representation, and mitigating hierarchical group dynamics. Our method faced unique software and hardware challenges, and raises certain questions regarding its effect on group functioning. Potential uses of our method are broad, and further studies are required.
Collapse
Affiliation(s)
- Samir Gupta
- Department of Medicine, University of Toronto, Toronto, Canada.
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
RATIONALE Multidisciplinary groups are common in the health care arena, from operating teams to mental health treatment groups to guideline development groups. Differences among group members in information, background, training and skills can potentially help groups reach good decisions and complete complex tasks in variable circumstances. Too often, however, differences in values, status and preferences prevent these groups from achieving the potential benefits of diversity, marooning them instead in an unproductive fixed state. AIM Drawing on the literature on diversity and complex adaptive systems, we discuss how to improve the functioning of multidisciplinary groups by increasing the spontaneous flow of information and energy to shift groups into the complex state. CONCLUSION Differentiation needs to be balanced by integration. Differences that pose obstacles need to be transformed into gradients to achieve complex self-organization and effective group coordination.
Collapse
Affiliation(s)
- Holly Arrow
- Psychology Department, Institute of Cognitive and Decision Sciences, University of Oregon, Eugene, Oregon 97403-1227, USA.
| | | |
Collapse
|
26
|
Gardner B, Davidson R, McAteer J, Michie S. A method for studying decision-making by guideline development groups. Implement Sci 2009; 4:48. [PMID: 19656366 PMCID: PMC2731071 DOI: 10.1186/1748-5908-4-48] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 08/05/2009] [Indexed: 11/22/2022] Open
Abstract
Background Multidisciplinary guideline development groups (GDGs) have considerable influence on UK healthcare policy and practice, but previous research suggests that research evidence is a variable influence on GDG recommendations. The Evidence into Recommendations (EiR) study has been set up to document social-psychological influences on GDG decision-making. In this paper we aim to evaluate the relevance of existing qualitative methodologies to the EiR study, and to develop a method best-suited to capturing influences on GDG decision-making. Methods A research team comprised of three postdoctoral research fellows and a multidisciplinary steering group assessed the utility of extant qualitative methodologies for coding verbatim GDG meeting transcripts and semi-structured interviews with GDG members. A unique configuration of techniques was developed to permit data reduction and analysis. Results Our method incorporates techniques from thematic analysis, grounded theory analysis, content analysis, and framework analysis. Thematic analysis of individual interviews conducted with group members at the start and end of the GDG process defines discrete problem areas to guide data extraction from GDG meeting transcripts. Data excerpts are coded both inductively and deductively, using concepts taken from theories of decision-making, social influence and group processes. These codes inform a framework analysis to describe and explain incidents within GDG meetings. We illustrate the application of the method by discussing some preliminary findings of a study of a National Institute for Health and Clinical Excellence (NICE) acute physical health GDG. Conclusion This method is currently being applied to study the meetings of three of NICE GDGs. These cover topics in acute physical health, mental health and public health, and comprise a total of 45 full-day meetings. The method offers potential for application to other health care and decision-making groups.
Collapse
Affiliation(s)
- Benjamin Gardner
- Centre for Outcomes Research and Effectiveness, Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | | | | | | | | |
Collapse
|
27
|
Gagnon MP, Lepage-Savary D, Gagnon J, St-Pierre M, Simard C, Rhainds M, Lemieux R, Gauvin FP, Desmartis M, Légaré F. Introducing patient perspective in health technology assessment at the local level. BMC Health Serv Res 2009; 9:54. [PMID: 19327160 PMCID: PMC2671501 DOI: 10.1186/1472-6963-9-54] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 03/27/2009] [Indexed: 11/17/2022] Open
Abstract
Background Recognizing the importance of increased patient participation in healthcare decisions leads decision makers to consider effective ways to incorporate patient perspectives in Health Technology Assessment (HTA) processes. The implementation of local health HTA units in university hospitals in Quebec provides a unique opportunity to foster an increased participation of patients in decisions regarding health technologies and clinical interventions. This project explores strategies that could be effective in involving patients in HTA activities at the local level. To do so, three objectives are pursued: 1) To synthesise international knowledge and experiences on patient and public involvement in HTA activities; 2) To explore the perceptions of stakeholders (administrators, clinical managers, healthcare professionals, HTA producers, and patients) regarding strategies for involving patients in various HTA activities; and 3) To produce a consensual strategic framework that could guide interventions for involving patients in HTA activities at the local level. Methods A systematic review of the literature will be conducted to synthesise international knowledge and experiments regarding the implication of patients and public in HTA. Then, focus groups will be carried out with representatives of various stakeholder groups in order to explore their perceptions regarding patient participation in HTA. Based on findings from the systematic review and the focus groups, a framework to support patient participation in HTA activities will be proposed. It will then be validated during a deliberative meeting with the research team, composed of scientists and decision makers, and representatives from different groups involved in HTA in Quebec. This deliberative meeting will aim at identifying the type and the degree of participation as well as the adequate timing for involving patients in local HTA activities. Discussion Given the actual state of evidence, integrating patient perspective in HTA activities has the potential to improve the quality of healthcare services. This study provides an opportunity to bridge the gap between HTA producers and its ultimate end-user: the patient. It will provide guidance to support local HTA units in Quebec and elsewhere in their decisions regarding patient participation. The framework developed could be applied to design and implement strategies for involving patients in HTA activities.
Collapse
|
28
|
Hammond CL, Phillips MF, Pinnington LL, Pearson BJ, Fakis A. Appropriateness of acute admissions and last in-patient day for patients with long term neurological conditions. BMC Health Serv Res 2009; 9:40. [PMID: 19250523 PMCID: PMC2653500 DOI: 10.1186/1472-6963-9-40] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 02/27/2009] [Indexed: 11/16/2022] Open
Abstract
Background To examine the appropriateness of admissions and in-patient stay for patients with long term neurological conditions (LTNCs). To identify variables predictive of appropriateness and explore management alternatives. Methods Adults admitted as acute patients to Derby Hospitals NHS Foundation Trust (England). Data were collected prospectively and examined by a multi-disciplinary expert panel to determine the appropriateness of admission and length of stay (LoS). Management alternatives were discussed. Results A total of 119 participants were recruited. 32 admissions were inappropriate and 83 were for an inappropriate duration. Whether a participant lived in their own home was predictive of an inappropriate admission. The number of LTNCs, number of presenting complaints and whether the participant lived alone in their own home were predictive of an inappropriate LoS. For admissions judged to be inappropriate, the panel suggested management alternatives. Conclusion Patients with LTNCs are being admitted to hospital when other services, e.g. ambulatory care, are available which could meet their needs. Inefficiencies in hospital procedures, such as discharge planning and patient transfers, continue to exist. Recognition of the need to plan for discharge at admission and to ensure in-patient services are provided in a timely manner may contribute towards improved efficiency.
Collapse
Affiliation(s)
- Christina L Hammond
- Rehabilitation Research and Education Group, School of Community Health Sciences, University of Nottingham, UK.
| | | | | | | | | |
Collapse
|
29
|
Edwards N, Semenic S, Premji S, Montgomery P, Williams B, Olson J, Mansi O. Provincial prenatal record revision: a multiple case study of evidence-based decision-making at the population-policy level. BMC Health Serv Res 2008; 8:266. [PMID: 19099585 PMCID: PMC2642799 DOI: 10.1186/1472-6963-8-266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 12/19/2008] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is a significant gap in the knowledge translation literature related to how research evidence actually contributes to health care decision-making. Decisions around what care to provide at the population (rather than individual) level are particularly complex, involving considerations such as feasibility, cost, and population needs in addition to scientific evidence. One example of decision-making at this "population-policy" level involves what screening questions and intervention guides to include on standardized provincial prenatal records. As mandatory medical reporting forms, prenatal records are potentially powerful vehicles for promoting population-wide evidence-based care. However, the extent to which Canadian prenatal records reflect best-practice recommendations for the assessment of well-known risk factors such as maternal smoking and alcohol consumption varies markedly across Canadian provinces and territories. The goal of this study is to better understand the interaction of contextual factors and research evidence on decision-making at the population-policy level, by examining the processes by which provincial prenatal records are reviewed and revised. METHODS Guided by Dobrow et al.'s (2004) conceptual model for context-based evidence-based decision-making, this study will use a multiple case study design with embedded units of analysis to examine contextual factors influencing the prenatal record revision process in different Canadian provinces and territories. Data will be collected using multiple methods to construct detailed case descriptions for each province/territory. Using qualitative data analysis techniques, decision-making processes involving prenatal record content specifically related to maternal smoking and alcohol use will be compared both within and across each case, to identify key contextual factors influencing the uptake and application of research evidence by prenatal record review committees. All study participants will be required to give written informed consent prior to participating in data collection. CONCLUSION This study will advance knowledge in the field of evidence-based decision-making by illustrating the complex interaction of contextual factors and evidence on health policy decision-making by provincial-level committees. By increasing the transparency of decision-making within provincial prenatal record committees, this study will help inform more effective strategies for enhancing the integration of best-practice evidence into prenatal records.
Collapse
Affiliation(s)
- Nancy Edwards
- University of Ottawa, 451 Smyth Road, Roger Guindon Pavilion 1118, Ottawa, Ontario, K1H 8M5, Canada
| | - Sonia Semenic
- School of Nursing, McGill University, 3506 University Street, Montreal, Quebec, H3A 2A7, Canada
| | - Shahirose Premji
- Faculty of Nursing, University of Calgary, Health Region, Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Phyllis Montgomery
- School of Nursing, Laurentian University, Ramsey Lake Road, Sudbury, Ontario, P3E 2C6, Canada
| | - Beverly Williams
- Faculty of Nursing, University of Alberta, 114th Street, 3rd Floor Clinical Sciences Building, Edmonton, Alberta, T6G 2G3, Canada
| | - Joanne Olson
- Faculty of Nursing, University of Alberta, 114th Street, 3rd Floor Clinical Sciences Building, Edmonton, Alberta, T6G 2G3, Canada
| | - Omaima Mansi
- School of Nursing, McGill University, 3506 University Street, Montreal, Quebec, H3A 2A7, Canada
| |
Collapse
|
30
|
Uhlig K, Balk EM, Lau J. Grading evidence-based guidelines--what are the issues? Am J Kidney Dis 2008; 52:211-5. [PMID: 18640485 DOI: 10.1053/j.ajkd.2008.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 06/17/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Katrin Uhlig
- Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
| | | | | |
Collapse
|
31
|
Michie S, Berentson-Shaw J, Pilling S, Feder G, Dieppe P, Raine R, Cluzeau F, Alderson P, Ellis S. Turning evidence into recommendations: protocol of a study guideline development groups. Implement Sci 2007; 2:29. [PMID: 17803806 PMCID: PMC2031892 DOI: 10.1186/1748-5908-2-29] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 09/05/2007] [Indexed: 11/16/2022] Open
Abstract
Background Health care practice based on research evidence requires that evidence is synthesised, and that recommendations based on this evidence are implemented. It also requires an intermediate step: translating synthesised evidence into practice recommendations. There is considerable literature on evidence synthesis and implementation, but little on how guideline development groups (GDGs) produce recommendations. This is a complex process, with many influences on communication and decision-making, e.g., the quality of evidence, methods of presentation, practical/resource constraints, individual values, professional and scientific interests, social and psychological processes. To make this process more transparent and potentially effective, we need to understand these influences. Psychological theories of decision-making and social influence provide a framework for this understanding. Objectives This study aims to investigate the processes by which GDGs formulate recommendations, drawing on psychological theories of decision-making and social influence. The findings will potentially inform the further evolution of GDG methods, such as choice of members and procedures for presenting evidence, conducting discussion and formulating recommendations. Methods Longitudinal observation of the meetings of three National Institute of Health and Clinical Excellence (NICE) GDGs, one from each of acute, mental health and public health, will be tape recorded and transcribed. Interviews with a sample of GDG members at the beginning, middle, and end of the GDG's work will be recorded and transcribed. Site documents including relevant e-mail interchanges, GDG meeting minutes, and stakeholders' responses to the drafts of the recommendations will be collected. Data will be selected for analysis if they refer to either evidence or recommendations; the focus is on "hot spots", e.g., dilemmas, conflicts, and uncertainty. Data will be analysed thematically and by content analysis, drawing on psychological theories of decision-making and social influence.
Collapse
Affiliation(s)
- Susan Michie
- Health Services Research Collaboration, University of Bristol and Centre for Outcomes Research and Effectiveness, Department of Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Jessica Berentson-Shaw
- Centre for Outcomes Research and Effectiveness, Department of Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Department of Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Gene Feder
- Centre for health sciences, Institute of Health Sciences Education, Barts andthe London Queen Mary's School of Medicine and Dentistry, 2 Newark Street, London E1 2AT, UK
| | - Paul Dieppe
- MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK
| | - Rosalind Raine
- Department of Epidemiology & Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Francoise Cluzeau
- Centre for Clinical Practice, National Institute for Health and Clinical Excellence, (NICE), MidCity Place, 71 High Holborn, London WC1V 6NA, UK
| | - Phil Alderson
- Centre for Clinical Practice, National Institute for Health and Clinical Excellence, (NICE), MidCity Place, 71 High Holborn, London WC1V 6NA, UK
| | - Simon Ellis
- Centre for Public Health Excellence, National Institute for Health and Clinical Excellence, (NICE), MidCity Place, 71 High Holborn, London WC1V 6NA, UK
| |
Collapse
|
32
|
McAlister FA, van Diepen S, Padwal RS, Johnson JA, Majumdar SR. How evidence-based are the recommendations in evidence-based guidelines? PLoS Med 2007; 4:e250. [PMID: 17683197 PMCID: PMC1939859 DOI: 10.1371/journal.pmed.0040250] [Citation(s) in RCA: 177] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 06/20/2007] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Treatment recommendations for the same condition from different guideline bodies often disagree, even when the same randomized controlled trial (RCT) evidence is cited. Guideline appraisal tools focus on methodology and quality of reporting, but not on the nature of the supporting evidence. This study was done to evaluate the quality of the evidence (based on consideration of its internal validity, clinical relevance, and applicability) underlying therapy recommendations in evidence-based clinical practice guidelines. METHODS AND FINDINGS A cross-sectional analysis of cardiovascular risk management recommendations was performed for three different conditions (diabetes mellitus, dyslipidemia, and hypertension) from three pan-national guideline panels (from the United States, Canada, and Europe). Of the 338 treatment recommendations in these nine guidelines, 231 (68%) cited RCT evidence but only 105 (45%) of these RCT-based recommendations were based on high-quality evidence. RCT-based evidence was downgraded most often because of reservations about the applicability of the RCT to the populations specified in the guideline recommendation (64/126 cases, 51%) or because the RCT reported surrogate outcomes (59/126 cases, 47%). CONCLUSIONS The results of internally valid RCTs may not be applicable to the populations, interventions, or outcomes specified in a guideline recommendation and therefore should not always be assumed to provide high-quality evidence for therapy recommendations.
Collapse
Affiliation(s)
- Finlay A McAlister
- The Division of General Internal Medicine, University of Alberta, Edmonton, Canada.
| | | | | | | | | |
Collapse
|
33
|
Nasser M, Oxman AD, Paulsen E, Fedorowicz Z. Local consensus processes: effects on professional practice and health care outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007. [DOI: 10.1002/14651858.cd003165.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mona Nasser
- Institute for Quality and Efficiency in Health care ; Department of Health Information; Dillenburger Street 27, D-51105 Köln Germany D-51105
| | - Andrew D Oxman
- Norwegian Knowledge Centre for Health Services; P.O. Box 7004, St. Olavs plass Oslo Norway N-0130
| | - Elizabeth Paulsen
- Norwegian Knowledge Centre for Health Services; Department of Evidence-Based Health Services; P.O. Box 7004, St. Olavs plass Oslo Norway N-0130
| | - Zbys Fedorowicz
- Ministry of Health, Bahrain; UKCC (Bahrain Branch); Box 25438 Awali Bahrain
| |
Collapse
|
34
|
Reynales-Shigematsu LM, Campuzano-Rincón JC, Sesma-Vásquez S, Juárez-Márquez SA, Valdés-Salgado R, Lazcano-Ponce E, Hernández-Avila M. Costs of medical care for acute myocardial infarction attributable to tobacco consumption. Arch Med Res 2006; 37:871-9. [PMID: 16971228 DOI: 10.1016/j.arcmed.2006.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 02/24/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Tobacco consumption is the principal modifiable risk factor causally associated with acute myocardial infarction (AMI). AMI has been an increasing and important cause of death in Mexico since 1980. METHODS To estimate the direct health care costs of AMI, we carried out a cost of illness (COI) analysis, using data derived from an expert panel consensus and from medical chart review. We used the smoking attributable fraction (SAF) estimates to derive costs of tobacco consumption. We also estimated the benefits of a "Smoke-free Workplace" tobacco control policy in terms of avoidable deaths and health care costs savings. RESULTS We estimated an annual average costs of 6,420 US dollars and 9,216 US dollars for non-ST segment elevation AMI (NSTEMI) and ST segment elevation AMI (STEMI), respectively. The total annual health care costs estimated for incident AMI for the IMSS state-level division of Morelos reached 2.9 million US dollars, of which 1.6 million US dollars was directly attributed to tobacco consumption. CONCLUSIONS Our results confirm the high costs associated with smoking and show the potential benefits resulting from a tobacco control policy. Our estimates are only applicable to social security in the state-level division of Morelos and more likely represent a lower boundary of the total costs of cardiovascular diseases attributed to tobacco, because we based the costs estimation on incident cases, and we did not take into consideration the costs derived from prevalent cases, indirect costs or other intangibles.
Collapse
|
35
|
Martens JD, Winkens RAG, van der Weijden T, de Bruyn D, Severens JL. Does a joint development and dissemination of multidisciplinary guidelines improve prescribing behaviour: a pre/post study with concurrent control group and a randomised trial. BMC Health Serv Res 2006; 6:145. [PMID: 17081285 PMCID: PMC1635708 DOI: 10.1186/1472-6963-6-145] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Accepted: 11/02/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is difficult to keep control over prescribing behaviour in general practices. The purpose of this study was to assess the effects of a dissemination strategy of multidisciplinary guidelines on the volume of drug prescribing. METHODS The study included two designs, a quasi-experimental pre/post study with concurrent control group and a random sample of GPs within the intervention group. The intervention area with 53 GPs was compared with a control group of 54 randomly selected GPs in the south and centre of the Netherlands. Additionally, a randomisation was executed in the intervention group to create two arms with 27 GPs who were more intensively involved in the development of the guideline and 26 GPs in the control group. A multidisciplinary committee developed prescription guidelines. Subsequently these guidelines were disseminated to all GPs in the intervention region. Additional effects were studied in the subgroup trial in which GPs were invited to be more intensively involved in the guideline development procedure. The guidelines contained 14 recommendations on antibiotics, asthma/COPD drugs and cholesterol drugs. The main outcome measures were prescription data of a three-year period (one year before and 2 years after guideline dissemination) and proportion of change according to recommendations. RESULTS Significant short-term improvements were seen for one recommendation: mupirocin. Long-term changes were found for cholesterol drug prescriptions. No additional changes were seen for the randomised controlled study in the subgroup. GPs did not take up the invitation for involvement. CONCLUSION Disseminating multidisciplinary guidelines that were developed within a region, has no clear effect on prescribing behaviour even though GPs and specialists were involved more intensively in their development. Apparently, more effort is needed to bring about change.
Collapse
Affiliation(s)
- Jody D Martens
- Integrated Care Unit, University Hospital Maastricht, The Netherlands
- Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands
| | - Ron AG Winkens
- Integrated Care Unit, University Hospital Maastricht, The Netherlands
- Department of General Practice, Maastricht University, The Netherlands
| | - Trudy van der Weijden
- Department of General Practice, Maastricht University, The Netherlands
- Centre for Quality of Care Research (WOK), University of Nijmegen and Maastricht University, The Netherlands
| | - Daisy de Bruyn
- Integrated Care Unit, University Hospital Maastricht, The Netherlands
| | - Johan L Severens
- Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands
- Department of Health Organisation, Policy, and Economics (BEOZ), Maastricht University, The Netherlands
| |
Collapse
|
36
|
Verkerk K, Van Veenendaal H, Severens JL, Hendriks EJM, Burgers JS. Considered judgement in evidence-based guideline development. Int J Qual Health Care 2006; 18:365-9. [PMID: 16959800 DOI: 10.1093/intqhc/mzl040] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Clinical practice guidelines should be based on the best available evidence. However, this evidence is often incomplete, controversial, or lacking. Other considerations beyond the evidence are therefore needed to be able to formulate specific and applicable recommendations for clinical practice. OBJECTIVE The aim of this study is to obtain consensus among experts about a set of domains and items covering the most relevant 'other considerations' to formulate recommendations in evidence-based guideline development. METHODS An initial list of 10 domains and 49 items for a systematic and considered judgement of scientific evidence was generated from the literature. A panel of Dutch experts in guideline development tested this list using a two-round Delphi consensus technique. Each expert was asked to independently score the relevance of the items on a 4-point Likert scale, ranging from 'very important' to 'not important'. The final list consisted of items that were included by at least 60% consensus. RESULTS Twenty-eight experts participated in the first Delphi round and 21 of them in the second round. High scoring domains were 'clinical relevance', 'safety', and 'availability of resources'. There was consensus about the relevance of 37 items. The domain 'conflicts of interest by industry' was excluded because of lack of consensus. CONCLUSION This is the first formal consensus approach towards structuring the considered judgement process in formulating recommendations in clinical guidelines. The final list of items can be used to facilitate the process of guideline development. The next step is to test the practical usefulness and applicability of this list in guideline development.
Collapse
Affiliation(s)
- Karin Verkerk
- Dutch Institute for Healthcare Improvement (CBO), Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
37
|
Moreira T, May C, Mason J, Eccles M. A new method of analysis enabled a better understanding of clinical practice guideline development processes. J Clin Epidemiol 2006; 59:1199-206. [PMID: 17027431 DOI: 10.1016/j.jclinepi.2005.08.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2004] [Revised: 08/12/2005] [Accepted: 08/20/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the process by which various forms of evidence are discussed, valued, and interpreted within the process of developing evidence-based clinical practice guidelines and, in so doing, to develop a method for such studies. STUDY DESIGN AND SETTING An observational study. Two guideline development groups were observed by a nonparticipant observer. The 21 meetings were recorded, transcribed, and analyzed using grounded theory and frame analysis. Qualitative analysis was complemented with descriptive statistics. RESULTS The groups organized their discussion around four domains--'science', 'practice', politics', and 'process'--and used boundary work to mediate between these domains. Both groups spent most time discussing 'science', followed by 'practice' or its relation with 'science'. CONCLUSION Our analysis offers an innovative, replicable method of analysis of guideline development that permits the identification of the proportions and interrelations between knowledge domains deployed by guideline groups. This analysis also suggests that the participation hierarchy observed here and by others might be an effect of the imbalanced use of knowledge domains in the construction of clinical guidance. This constitutes an important framework to understand the interplay of participants and knowledge in guideline development.
Collapse
Affiliation(s)
- Tiago Moreira
- Centre for Health Services Research, School of Population and Health Sciences, University of Newcastle upon Tyne, 21 Claremont Place, Newcastle upon Tyne NE2 4AA, UK
| | | | | | | |
Collapse
|
38
|
Mason JM, Delaney B, Moayyedi P, Thomas M, Walt R. Managing dyspepsia without alarm signs in primary care: new national guidance for England and Wales. Aliment Pharmacol Ther 2005; 21:1135-43. [PMID: 15854176 DOI: 10.1111/j.1365-2036.2005.02445.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To report new recommendations for the primary care management of dyspepsia without alarm signs in England and Wales. METHOD An independent, representative group of health care professionals, patient representatives and researchers developed the guideline using evidence-based and small group-working principles, and incorporated extensive peer-reviewing and feedback from stakeholder organizations. RESULTS Referral to investigate dyspepsia should be made for alarm signs and not on the basis of age alone, reflecting the balance of benefit and harm from endoscopy. Empirical management without formal diagnosis is appropriate for most patients: reviewing patient history, lifestyle, over-the-counter medicines, and providing a course of proton-pump inhibitors and/or Helicobacter pylori test and treatment. Patients with ongoing symptoms require at least annual review to discuss symptoms and lifestyle, and as appropriate, encourage stepping down prescribed medication and returning to self-care. A new strategy included in the step down process is the use of therapies 'on-demand'. CONCLUSION The guideline provides structured and supported recommendations for both undiagnosed and endoscopically investigated dyspepsia. Some favour increased investigation to detect Barrett's oesophagus and carcinoma. However, there is inconclusive evidence that patients without alarm signs will benefit subsequently from endoscopy, while investigation involves a small but real risk of harm.
Collapse
Affiliation(s)
- J M Mason
- School for Health, University of Durham, Queen's Campus, Wolfson Research Unit, University Boulevard, Stockton-on-Tees UK.
| | | | | | | | | |
Collapse
|
39
|
Affiliation(s)
- Jako S Burgers
- Dutch Institute for Healthcare Quality, 3502 LB Utrecht, Netherlands.
| | | |
Collapse
|
40
|
Rogers W. Evidence-based medicine and women: do the principles and practice of EBM further women's health? BIOETHICS 2004; 18:50-71. [PMID: 15168698 DOI: 10.1111/j.1467-8519.2004.00378.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Clinicians and policy makers the world over are embracing evidence-based medicine (EBM). The promise of EBM is to use summaries of research evidence to determine which healthcare interventions are effective and which are not, so that patients may benefit from effective interventions and be protected from useless or harmful ones. EBM provides an ostensibly rational objective means of deciding whether or not an intervention should be provided on the basis of its effectiveness, in theory leading to fair and effective healthcare for all. In this paper I closely examine these claims from the perspective of healthcare for women, using relevant examples. I argue that the current processes of evidence-based medicine contain a number of biases against women. These biases occur in the production of research that informs evidence-based medicine, in the methods used to analyse and synthesise the evidence, and in the application of EBM through the use of guidelines. Finally, the biomedical model of health that underpins most of the medical research used by EBM ignores the social and political context which contributes so much to the ill-health of women.
Collapse
Affiliation(s)
- Wendy Rogers
- Department of General Practice, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
| |
Collapse
|
41
|
Cook SA, Rosser R, Meah S, James MI, Salmon P. Clinical decision guidelines for NHS cosmetic surgery: analysis of current limitations and recommendations for future development. BRITISH JOURNAL OF PLASTIC SURGERY 2003; 56:429-36. [PMID: 12890455 DOI: 10.1016/s0007-1226(03)00183-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Because of increasing demand for publicly funded elective cosmetic surgery, clinical decision guidelines have been developed to select those patients who should receive it. The aims of this study were to identify: the main characteristics of such guidelines; whether and how they influence clinical decision making; and ways in which they should be improved. UK health authorities were asked for their current guidelines for elective cosmetic surgery and, in a single plastic surgery unit, we examined the impact of its guidelines by observing consultations and interviewing surgeons and managers. Of 115 authorities approached, 32 reported using guidelines and provided sufficient information for analysis. Guidelines mostly concerned arbitrary sets of cosmetic procedures and lacked reference to an evidence base. They allowed surgery for specified anatomical, functional or symptomatic reasons, but these indications varied between guidelines. Most guidelines also permitted surgery 'exceptionally' for psychological reasons. The guidelines that were studied in detail did not appreciably influence surgeons' decisions, which reflected criteria that were not cited in the guidelines, including cost of the procedure and whether patients sought restoration or improvement of their appearance. Decision guidelines in this area have several limitations. Future guidelines should: include all cosmetic procedures; be informed by a broad range of evidence; and, arguably, include several nonclinical criteria that currently inform surgeons' decision-making.
Collapse
Affiliation(s)
- S A Cook
- St Helens and Knowsley Hospitals NHS Trust, Whiston Hospital, Prescot, Merseyside, UK
| | | | | | | | | |
Collapse
|
42
|
Pagliari C, Grimshaw J. Impact of group structure and process on multidisciplinary evidence-based guideline development: an observational study. J Eval Clin Pract 2002; 8:145-53. [PMID: 12180363 DOI: 10.1046/j.1365-2753.2002.00333.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES This paper presents selected results from a study investigating the impact of small group processes on the development of clinical practice guidelines by multidisciplinary panels. Observations of one panel developing a guideline for primary care over several months are reported here. METHODS Non-participant observation with content analy-sis of transcripts aided by field notes. RESULTS Bales's interaction process analysis was used to categorize interactions in terms of their task-oriented or socioemotional qualities. This revealed a well-functioning, task-oriented group characterized by predominantly positive social behaviours. However, a breakdown of dialogue by speaker indicated a marked effect of professional role and status on the level of contribution to group discussions. This, and marked changes in panel composition across meetings, has implications for the multidisciplinarity of decision-making in such groups and hence for the acceptance and implementation of their outputs. CONCLUSIONS These findings are likely to generalize to other health care settings in view of the growing emphasis on multidisciplinary decision-making and the clear status hierarchies inherent within the medical and allied fields.
Collapse
|
43
|
Miles A, Bentley P, Polychronis A, Grey J, Melchiorri C. Recent developments in the evidence-based healthcare debate. J Eval Clin Pract 2001; 7:85-9. [PMID: 11489033 DOI: 10.1046/j.1365-2753.2001.00301.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|