The Guideline Implementability Decision Excellence Model (GUIDE-M): a mixed methods approach to create an international resource to advance the practice guideline field

Implementation Science

Onil Bhattacharyya¹  Leigh Hayden³  Monika Kastner⁴  Julie Makarski²  Melissa C Brouwers² 

[1] Women’s College Hospital & University of Toronto, Toronto, Ontario, Canada;McMaster University & the Escarpment Cancer Research Institute, Hamilton, ON, Canada;Women’s College Hospital, Toronto, ON, Canada;Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada

关键词: Implementation;    Implementability;    Practice guidelines;    Clinical practice guidelines;   

Others  :  1139183
DOI  :  10.1186/s13012-015-0225-1

 received in 2014-09-23, accepted in 2015-02-26,  发布年份 2015

【 摘 要 】

Background

Practice guideline (PG) implementability refers to PG features that promote their use. While there are tools and resources to promote PG implementability, none are based on an evidence-informed and multidisciplinary perspective. Our objectives were to (i) create a comprehensive and evidence-informed model of PG implementability, (ii) seek support for the model from the international PG community, (iii) map existing implementability tools on to the model, (iv) prioritize areas for further investigation, and (v) describe how the model can be used by PG developers, users, and researchers.

Methods

A mixed methods approach was used. Using our completed realist review of the literature of seven different disciplines as the foundation, an iterative consensus process was used to create the beta version of the model. This was followed by (i) a survey of international stakeholders (guideline developers and users) to gather feedback and to refine the model, (ii) a content analysis comparing the model to existing PG tools, and (iii) a strategy to prioritize areas of the model for further research by members of the research team.

Results

The Guideline Implementability for Decision Excellence Model (GUIDE-M) is comprised of 3 core tactics, 7 domains, 9 subdomains, 44 attributes, and 40 subattributes and elements. Feedback on the beta version was received from 248 stakeholders from 34 countries. The model was rated as logical, relevant, and appropriate. Seven PG tools were selected and compared to the GUIDE-M: very few tools targeted the Contextualization and Deliberations domain. Also, fewer of the tools addressed PG appraisal than PG development and reporting functions. These findings informed the research priorities identified by the team.

Conclusions

The GUIDE-M provides an evidence-informed international and multidisciplinary conceptualization of PG implementability. The model can be used by PG developers to help them create more implementable recommendations, by clinicians and other users to help them be better consumers of PGs, and by the research community to identify priorities for further investigation.

【 授权许可】

   
2015 Brouwers et al.; licensee BioMed Central.

【 参考文献 】

• [1]Brouwers M, Stacey D, O’Connor A: Knowledge translation tools. In Knowledge translation in health care: moving from evidence to practice. 2nd edition. Edited by Straus SE, Tetro J, Graham ID. John Wiley & Sons, Ltd, Oxford; 2013:50-62.
• [2]Clinical Practice Guidelines We can Trust. Washington, DC: The National Academies Press. 2011 [cited 2014 May 8]. Available from: http://www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx.
• [3]Tricoci P, Allen JM, Kramer JM, Califf RM, Smith SC Jr: Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA 2009, 301(8):831-41.
• [4]Grimshaw JM: The effectiveness of guideline dissemination and implementation strategies 1966–1998. J Gen Intern Med 2006, 21(2):14-20.
• [5]Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8(6):iii-iv, 1-72.
• [6]Schiffman R, Dixon J, Brandt C, Essaihi A, Hsiao A, Michel G, et al.: The Guideline Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation. BMC Med Info Dec Mak. 2005, 5:23. BioMed Central Full Text
• [7]Kastner M, Makarski J, Hayden L, Durocher L, Chatterjee A, Brouwers M, et al.: Making sense of complex data: a mapping process for analyzing findings of a realist review on guideline implementability. BMC Med Res Methodol 2013, 13:112. BioMed Central Full Text
• [8]Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al.: AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 2010, 182(18):E839-42.
• [9]Brouwers MC, Kho ME, Browman GP, Burgers J, Cluzeau F, Feder G, et al.: Performance, usefulness and areas for improvement: development steps towards the AGREE II–Part 1. Can Med Assoc J 2010, 182:1045-52.
• [10]Brouwers MC, Kho ME, Browman GP, Burgers J, Cluzeau F, Feder G, et al.: Validity assessment of items and tools to support application: development steps towards the AGREE II–Part 2. Can Med Assoc J 2010, 182:E472-478.
• [11]Gagliardi A, Brouwers MC, Palda VA, Lemieux-Charles L, Grimshaw JM: How can we improve guideline use? A conceptual framework of implementability. Implement Sci 2011, 6:26. BioMed Central Full Text
• [12]Gagliardi AR, Brouwers MC, Bhattacharyya OK: The guideline implementability research and application network (GIRAnet): an international collaborative to support knowledge exchange: study protocol. Implement Sci 2012, 7:26. doi:10.1186/1748-5908-7-26 BioMed Central Full Text
• [13]Qaseem A, Forland F, Macbeth F, Ollenschläger G, Philips S, van der Wees P: Guidelines international network: toward international standards for clinical practice guidelines. Ann Intern Med 2012, 156(7):525-31.
• [14]Schünemann HJ, Wiercioch W, Etxeandia I, Falavigna M, Santesso N, Mustafa R, et al. Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ. 2013. doi:10.1503/cmaj.131237.
• [15]Brouwers MC, Makarski J, Garcia K, Akram S, Darling GE, Ellis PM, et al.: A mixed methods approach to understand variation in lung cancer practice and the role of guidelines. Implement Sci 2014, 9:36. doi:10.1186/1748-5908-9-36 BioMed Central Full Text
• [16]Kastner M, Bhattacharyya O, Hayden L, Makarski J, Estey E, Durocher L, et al. Guideline uptake is influenced by 6 implementability domains for creating and communicating guidelines: a realist review. JCE, In press.
• [17]The ADAPTE Collaboration. The ADAPTE Process: resource toolkit for guideline adaptation. Version 2.0. 2009. Available from: http://www.g-i-n.net.
• [18]GRADE Working Group: Grading quality of evidence and strength of recommendations BMJ 2004, 328:1490.
• [19]Cancer Care Ontario: Program in Evidence-Based Care Handbook [Internet]. Cancer Care Ontario (CCO), Toronto (ON); 2012.
• [20]Scottish Intercollegiate Guidelines Network: SIGN 50: A guideline developer’s handbook. Scottish Intercollegiate Guidelines Network (SIGN), Edinburgh; 2011.
• [21]Shekelle PG, Ortiz E, Rhodes S, Morton SC, Eccles MP, Grimshaw JM, et al.: Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA. 2001, 286:1461-7.
• [22]AGREE Enterprise [Internet]. Hamilton (ON): AGREE Enterprise. 2014 [cited 2014 May 8]. Available from: http://www.agreetrust.org.
• [23]GRADE working group [Internet]. [place unknown]: GRADE working group. 2014 [cited 2014 May 8]. Available from: http://www.gradeworkinggroup.org.
• [24]Jan B, Andrew O, Holger S: GRADEpro. [Computer program]. Version 3.2 for Windows. 2008.
• [25]National Guideline Clearinghouse (NGC) [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). 2014 [cited 2014 May 8]. Available from: http://www.guideline.gov.
• [26]Guideline Implementability for Decision Excellence Model [Internet]. Hamilton (ON): AGREE Enterprise Project Office. 2014 [cited 2014 May 8]. Available from: http://www.guide-m.ca.