miércoles, 19 de mayo de 2010

An Integrated Approach to Developing Health Care Guidelines and Measures - NGC - Expert Resources - Expert Commentary


An Integrated Approach to Developing Health Care Guidelines and Measures

By: Cally Vinz, RN
Joann Foreman, RN
Kathy Cummings, RN

Overview


Since 1993, the Institute for Clinical Systems Improvement (ICSI) has developed more than 60 evidence-based health care guidelines that support best practices for the prevention, diagnosis, treatment, or management of a given symptom, disease, or condition for patients. The rigor of ICSI's development and review process has helped make ICSI guidelines a resource accessed in more than 130 countries, according to Google Web site usage data. In this commentary, we highlight the process, as well as address the challenges, of providing relevant guidelines for the future in light of emerging care delivery models and technological advances.

Potential Conflict of Interest

To maintain the integrity of our documents, ICSI has long implemented a policy of transparency, requiring disclosure of potential conflicts and competing interests by all individuals who participate in the development, revision, and approval of ICSI scientific documents. In 2009, ICSI established a Conflict of Interest Review Committee to review these disclosures and make recommendations to the ICSI Board of Directors regarding further steps that could be taken to mitigate potential conflicts. The ICSI board ultimately determines what steps to take to ensure the integrity and reliability of the ICSI guidelines.

Selection Process

The ICSI guideline development process starts with the Committee for Evidence-based Practice selecting topics based on the following criteria:

•Frequency of the topic in the care provided by ICSI members (50+ medical group and hospital members representing about 9,000 physicians)
•Probability of achieving change (closing the gap), including the likelihood of reaching agreement on the recommendations and of implementing the provisions of the document
•Anticipated improvements, including outcomes and waste reduction
•Health care environment, regulatory requirements, and other initiatives
To give ICSI a broad and timely perspective on which new guidelines to develop, topic ideas are solicited annually from all ICSI member groups and guideline work groups.

Document Development and Revision Process

Each guideline work group consists of 10 to 15 members, including physicians, nurses, pharmacists, other health care professionals relevant to the topic, and two ICSI staff members who facilitate the process, collate content components, and draft implementation recommendations and measures for work group consideration.

The development process is based on a number of long-proven approaches (1,2). ICSI staff first conducts a literature search to identify pertinent clinical trials, meta-analyses, systematic reviews, regulatory statements, and other professional guidelines. The literature is reviewed and graded based on the ICSI Evidence Grading System (see Appendix A below).

A key building block to guideline development is defining its clinical scope. Once the scope is defined and relevant literature is assembled, ICSI facilitators identify gaps between current and optimal practices (3). They then guide the work group through development of the clinical flow and algorithm, drafting of annotations and identification of the literature citations. ICSI staff reviews existing regulatory and standard measures and drafts outcome and process measures for work group consideration. The work group considers the importance of changing systems and physician behavior so that outcomes such as health status, patient and provider satisfaction, and cost/utilization (4) are maximized.

A distinctive component of the ICSI guidelines is their implementation recommendations, which are based on ICSI member experiences as well as on best practices identified in the literature. As members of ICSI, medical groups are committed to review ICSI guidelines up for revision. The medical groups provide feedback on new literature, identify areas needing clarification, offer recommended changes, outline successful implementation strategies, and list barriers to implementation. A summary of the feedback from all medical groups is provided to the guideline work group for use in the revision of the guideline.

A nominal group technique (5) is used to build work group consensus around all the guideline components. This allows for the free exchange of opinions and the generation of ideas within a structured and nonhierarchical discussion forum.

Critical Review Process

This step is unique, as it provides an opportunity for clinicians in integrated systems, hospitals, rural/metro independent practices and specialty groups to review the clinical recommendations, evidence, and clinical flow of the guideline prior to publishing. All ICSI member organizations are expected to critically review newly developed guidelines prior to final approval. This is an opportunity to review the science behind the recommendations and focus on the content of the guideline. Each organization speaks with one voice, submitting a consensus report of responses to all guideline components. This critical review process also allows each organization to consider system changes needed to implement the guideline.

As in the revision process, responses are submitted to the guideline development work group for consideration. The work group seeks additional literature as needed, revises the draft document, and responds to all the feedback, outlining why they did or did not integrate the recommended revisions into the guideline. This process challenges the work group's interpretation of the evidence and requires a clear presentation of the content.

open here to see the full-text:
NGC - Expert Resources - Expert Commentary

No hay comentarios: