bluuebunny/crossref_metadata_2025_split huggingface dataset:
P269 Adaptation Of A North American Institutionally Based Health Technology Assessment (Ihta) Model To A Private Brazilian Health Care Organization (Bhco)
Authors: Alves Da Silva S , Cabanelas Pazos M , Pereira de Souza P , Rascão Cardoso P , Wyer P 
Published: August 2013

BackgroundBrazilian Guidelines, developed by medical societies, are sparsely used by federal agencies to determine coverage. To date there is no organised approach to clinical policy and guideline development or for dialogue with regulators within BHCOs. Amil, the largest BHCO, covers 6 million lives distributed across 8 regions and delivers care to many through its own medical centres.ObjectivesTo develop a minimally resourced clinical policy and implementation capability within Amil together with a training programme on a national level.MethodsOur approach is based on observation of the Penn Health System and the Kaiser Permanente (KP) models of IHTA. We are profiling current capacity for integrating umbrella reviews with mining and interpretation of internally generated practice data, and are identifying resource and manpower needs. To promote cultural change on national scale we reformulated an annual training workshop made in partnership with NYAM and McMaster and opened to participants within and without Amil, including Health Ministry and Regulatory Agencies, by addressing guideline development, adaptation and implementation skills.ResultsOur approach identifies knowledge gaps within the organisation and develops related guidelines and outcomes assessment to be internally used through Electronic Health Records and to be presented to regulators as proposal for change. The framework was built on a piloted approach on bariatric surgery and on the identification of additional target areas. Our capacity building programme has trained over 250 individuals within and without Amil, including policy developers within regional and national health ministries.ConclusionAn IHTA programme within a BHCO may offer a capacity building model useful for national development.
P271 Computerized Guidelines Analysis: 5-Years Experience And User Feedback
Authors: Georg G , Siddle J , Truran M , Cavazza M 
Published: August 2013

BackgroundIn 2007, HAS (Haute Autorité de Santé, France) started experimenting the use of computerised guidelines analysis with the G-DEE software as part of the guidelines production process. G-DEE uses shallow natural language processing techniques to recognise the expression of recommendations in a guidelines’ text, and structures the document accordingly using on-screen text highlighting and colouring. Project managers were offered, on an entirely voluntary basis, the possibility of using this tool during the final phases of guidelines production to i) analyse overall guidelines structure and ii) review the formulation of individual recommendations. To date, this experiment has concerned 38% of guidelines that have been officially released.ObjectivesImproving the performance and usability of the deployed G-DEE system.MethodsWe have collected feedback from guidelines’ project managers who have identified clear benefits in terms of readability of individual recommendations, overall text balance, fine-tuning and testing of alternative wording. Main limitations identified were processing time, which required additional planning and the absence of a tuning facility that would allow different levels of grammar coverage.ResultsNotable enhancements include faster document processing (x10) and incremental document analysis allowing direct text input in the system.DiscussionThese will make its use possible throughout the production process, e.g. directly as part of consensus meetings once the first draft is available. In addition, the possibility to define additional grammar files for text processing supports the processing of new document types (shorter guidelines, summaries) which may adopt different writing styles.
P274 New National Governmental Guideline Program In Hungary
Authors: Kis E , Nagy E , Dobos E , Karpati E 
Published: August 2013

BackgroundIn Hungary officially 493 clinical practice guidelines (CPGs) were released by the Ministry of Health. Since most of the published guidelines were developed in 2005 and 2006, the updating process is necessary. In Hungary traditionally, professional associations develop guidelines. In lack of a dedicated guideline clearinghouse with an evidence-based methodological support function, mostly non-systematic, non-evidence-based or traditional methods were used when formulating recommendations.ContextTo solve these anomalies, the National Institute for Quality- and Organisational Development in Healthcare and Medicines (NIQODHM) set up an expert group of evidence based methodologists to systematically revise the existing clinical guidelines and support the updating process. The expert group assessed the methodological quality of 90% of the existing CPGs by the AGREE instrument: most CPGs scored rather low on the stakeholder involvement, rigour of development, applicability, and editorial independence domains. Therefore our aim is to encourage the professional associations to improve these shortcomings.Description of Best PracticeThe NIQODHM developed a web-based application to support this project and coordinates the participation of all relevant professional groups in the development teams. User-friendly tools for adaptation of evidence-based guidelines, based on internationally published methods and materials are developed and personal consultations are provided by the expert group of methodologists. To guarantee the independence of national guidelines, a regulated declaration process for Conflict of Interest is also introduced.Lessons for Guideline Developers, AdaptorsWe do believe that methodological support tools will contribute to the development of higher quality and more applicable recommendations.
279WS Using A New Analytic Framework To Create Evidence-Based Coverage Guidance
Authors: King V , Little A , Vandegriff S 
Published: August 2013

BackgroundA state passed comprehensive health reform legislation in 2009 that directed it to develop a process to translate evidence into coverage guidance to be applied rapidly and uniformly across public and private healthcare payers. A Governor-appointed committee managing the state’s Medicaid benefit package developed an analytic framework with a decision algorithm to facilitate coverage decisions. The framework is built upon six decision point priorities: sufficiency of evidence, effectiveness of the treatment and availability of alternatives, treatment risk, cost, prevalence of treatment and research feasibility.Objectives/GoalTo practice applying decision-making principles and best available evidence to reach coverage decisions.Target Group, Suggested AudiencePolicy makers, guideline developers and users.Description of the Workshop and of the Methods used to Facilitate InteractionsA short didactic presentation will present the analytic framework development history. We will discuss alternative priorities that could have been adopted. Participants will then work in facilitated small groups to reach coverage decisions using the framework and algorithm. Each small group will have a summary of the evidence available. The topics will include surgery for femoroacetabular syndrome, carotid endarterectomy and treatment of attention deficit hyperactivity disorder. Facilitators will encourage participants to attempt to reach a coverage decision as if they were a policy-making body and will assist with interpretation of the evidence. The group will identify and consider any potential implementation barriers or considerations and propose management strategies. The groups will share their experience using the framework and the facilitators will present the actual decisions the state committee made.
P309 Serious Games As A New Medium For Patients Guidelines Dissemination
Authors: Georg G , Cavazza M , Charles F , Smith C 
Published: August 2013

BackgroundPatient education documents are faced with a number of issues that limit their dissemination, from intrinsic readability to how they appeal to patients. Previous studies have demonstrated a positive impact of visual media across the range of patients’ literacy skills, both health-specific and generic.ObjectivesTo devise a production mechanism for serious games in patient education aligned with the current development of patient guidelines, keeping costs manageable in the long term.MethodsThe MUSE FP7 Project, funded by the European Commission, brings together computer scientists, cognitive psychologists and one GIN member. The project investigates the long-term potential of automatic generation of serious games from patient guidelines documents. It uses state-of-the art commercial gaming technology as well as developing new text analysis software.ResultsA first prototype has been developed on the topic of bariatric surgery education. It features male and female patient avatars in a hospital environment and supports the interactive exploration and rehearsal of the various stages of the process. All the game actions can be related to specific portions of the patient education document.DiscussionThe popularity of new media such as computer games improves dissemination prospects for patient education information. In addition, as suggested by recent research, the interactive nature of serious games makes the information more accessible, facilitates learning and addresses issues not covered by textual dissemination such as patient anxiety.Implications for Guideline Developers/UsersSerious gaming is poised to become a major health-related medium, hence the need for specific development processes.
003 Towards optimal patient involvement in guideline development groups
Authors: Lange-Tichelaar T De , Pittens C , Verhoof E , Maes L , Kersten S , Broerse J 
Published: August 2013

BackgroundThe involvement of patient representatives in guideline development groups (GDGs) could increase legitimacy and quality of clinical practice guidelines (CPGs), since the experiential knowledge of patients could complement scientific evidence. By their involvement, patients have the opportunity to share (consultation) and incorporate their views and experiences into CPGs (decision-making). Although the importance of this approach is emphasised, little methodological support and systematic reflection exist on effective strategies.ObjectivesTo gain insight in how patient involvement in GDGs can be optimised in order to develop strategies which can be implemented in practice.MethodsThe evaluation consisted of a desk study and 23 semi-structured interviews with stakeholders in CPGs, including patient representatives. The acquired insights were used to develop an evaluation framework, which guided monitoring and evaluation of four ongoing oncological guideline development processes. Validation took place through a triangulated approach (e.g. observations, document-analyses, interviews). Two patient representatives were included in the research team.ResultsThe evaluation revealed that successful patient involvement in GDGs depends on a broad scale of factors (e.g. members of the GDGs, support of patient representatives) which could facilitate or constrain patient involvement. The factors were used to develop practical strategies for patient involvement, ranging from preparation meetings to regular reflections with the patient representatives and dialogue sessions with patients.DiscussionThe strategies could lead to more successful patient involvement in GDGs and provide valuable insights on how to involve patients in guideline development processes on other disease areas.
022 Developing guidelines and quality indicators simultaneously: effects on guideline content and implications on the guideline development process
Authors: Follmann M , Wesselmann S , Kopp I , Nothacker M 
Published: August 2013

BackgroundThe German Guideline programme in Oncology (GGPO) funds and supports the development, implementation and evaluation of evidence based guidelines. An essential part of the programme is the development of quality indicators (QI) before a guideline is published. QI groups representing the multidisciplinary guideline development group including patient representatives and experts from organisations responsible for QI assessment and evaluation realise this following a standardised methodology.ObjectivesTo explore the effects of a standardised Quality Indicator Development Process (QIDP) on the content of guidelines and possible implications on the guideline development process.MethodsRetrospective content analysis of current guideline manuscripts. Description and categorization of changes in the guideline draft after the QIDP. Structured interview of QI groups.Results9 oncological guidelines including 87 QI were analysed. Changes in guideline drafts after the QIDP included: • formulation of new recommendations • specification of the wording of recommendations • specification and amendment of the predefined aims of a guideline • identification of aspects to consider for an update of the guideline. Results of the interview will be presented at the conference.DiscussionThis investigation suggests a positive effect of the simultaneous QI development on guideline content concerning specificity of recommendations, clarity of aims to improve quality of care and identification of clinical questions to be addressed in future systematic reviews and/or guidelines.Implications for Guideline DevelopersA simultaneous process to develop guidelines and QI is favourable not only to facilitate the assessment of guideline implementation and impact but also to improve guideline content and implementability.
029 Clinical Practice Guidelines for Australian General Practitioners: How Implementable Are They?
Authors: Chakraborty S , Mazza D 
Published: August 2013

BackgroundMany guidelines have been published that are relevant to Australian general practitioners. However, it is unclear whether these guidelines have the attributes required for facilitating implementation.ObjectivesTo determine the proportion of current Australian general practice guidelines that have incorporated the attributes required for facilitating implementation.MethodsWe conducted an audit of the National Health and Medical Research Council Clinical Guidelines Portal to identify guidelines published between 2007 and 2011 that listed general practitioners (GPs) as a primary user and examined them for attributes identified in literature as facilitating implementation.ResultsA total of 146 guidelines targeting Australian GPs were identified in our study. Approximately 46% of these guidelines were developed by “collaborating authors”, with 27% and 19% developed by “government organisations” and “not-for-profit organisations”, respectively. Almost half (43%) of the guidelines did not state the methodology used, with 33% using “expert opinion” and only 16% using “systematic literature reviews”. Only 14% of the guidelines were endorsed by professional colleges and only 10% of the guidelines were government-approved. Additional resources to facilitate guideline uptake were included for only 23% of the guidelines.DiscussionWhile some attributes of implementation have been incorporated into general practice guidelines, many are absent from most of these guidelines. Given the rapid growth in evidence-based guidelines in Australia, it is imperative that clinical practice guidelines incorporate the attributes necessary for facilitating implementation.Implications for Guideline Developers/UsersDeveloping an evidence-based guideline implementability framework may be useful for improving the development and dissemination of guidelines.
031 If Rapid Reviews are the Answer, what is the Question?
Authors: Ireland B 
Published: August 2013

BackgroundThe Institute of Medicine recommended standards for systematic review, but some guideline developers find the standards time and resource intensive. Rapid reviews are becoming a popular method to appraise and summarise evidence. But what are rapid reviews and do they replace or rely on systematic review?ObjectivesTo clarify major differences between rapid reviews and systematic reviews, especially aims, methods and uses for guidelines and policy.MethodsOverview of reviews and examination of organisational policies for rapid review focusing on reasons users request rapid review, methods used to produce them, and the uses of those syntheses.ResultsThere is no standards methodology for producing rapid review, nor is there consistency in intended use. Some organisations rely on systematic reviews to produce rapid review, while others incorporate short cuts in systematic review process. In addition to faster production, some users of rapid review are seeking product that is more clinically relevant and ready for implementation.DiscussionThere are many ways to speed up systematic review, some at risk of introducing bias. Without clear understanding of the reasons users request rapid review and their expectations for the evidence product, simply speeding the time frame may not address all of user needs for evidence they can implement quickly.Implications for Guideline Developers/UsersUntil there is consensus on what the label rapid review describes, users will need to identify their own minimal standards and evaluate adherence. Developers should be clear about user expectations for using the evidence.
032 Rapid Guidelines: A Systematic Review
Authors: Falavigna M , Ikobaltzeta I , Sakhia F , Zhang Y , Santesso N , Norris S , Schünemann H 
Published: August 2013

BackgroundGuidelines often take two or more years to be developed. This timeframe is not practical for providing guidance in situations when rapid advice is needed.ObjectivesTo describe current practices about the development of rapid guidelines and to provide advice about adequate methodology.MethodsWe performed a systematic review, including grey literature, to identify (1) rapid guidelines, defined as guidelines produced in a shortened time frame, and (2) methodological manuals addressing its development.ResultsWe only documents by WHO and NICE that described methods and actual guidelines. The WHO handbook describes “rapid advice guidelines”; guidelines produced in response to a public health emergency in which WHO is required to provide rapid global leadership and guidance. This advice should be produced within 1 to 3 months and be evidence-informed, however, it may not be supported by full reviews of the evidence. We identified six WHO rapid guidelines and one methodological guidance paper based on a WHO guideline. NICE produces “short clinical guidelines”; guidelines that address only part of a care pathway, allowing rapid (11–13-month) development of guidance on aspects of care for which the NHS requires urgent advice. We identified 18 NICE short clinical guidelines.DiscussionLiterature is lacking about rapid guidelines and the intended role appears to differ. Despite its relevance, there are few rapid guidelines published and clarity about the terminology is needed.Implications for Guideline DevelopersWe will provide a framework for those developing rapid guidelines, including practical advice and clarification about the terminology used.
042 Strong Recommendation – Strong Evidence? An Analysis of Evidence-Based Guidelines on Various Chronic Diseases
Authors: Siering U , Waldt S Ein , Hoffmann-Eber W , Rüther A 
Published: August 2013

BackgroundSeveral studies have investigated the award of Grades of Recommendation (GoR) and Levels of Evidence (LoE) in clinical practice guidelines of medical societies.ObjectivesTo assess to what extent recommendations with high GoR are also linked to high LoE in guidelines on various chronic diseases.MethodsWe conducted a systematic search for German, English, and French-language evidence-based guidelines on type 1 and 2 diabetes, coronary heart disease, and heart failure published after 1995. Guideline recommendations on the healthcare aspects “diagnosis”, “treatment” and “cooperation of health care sectors”, including their LoE and GoR, were extracted. LoE and GoR were then rated according to aggregated evidence or recommendation categories (weak, medium, strong).Results71 guidelines were identified and 3918 recommendations extracted. 3073 (78%) and 2541 (65%) recommendations were supported by GoR and LoE respectively. 1879 recommendations (48%) were supported by both GoR and LoE. In this group, strong GoR were awarded in 839 cases (45%), but only 353 (42%) of them were also linked to strong LoE. Weak and medium LoE were awarded in 264 (32%) and 222 (27%) cases, respectively.DiscussionA large proportion of recommendations in evidence-based guidelines are not supported by both GoR and LoE; the quality of guidelines could be improved here. If both are reported, less than half of recommendations with strong GoR are also linked to strong LoE. This raises the question whether too high GoR are systematically awarded in clinical practice guidelines.
062 Partially Updating a Guideline to Improve its Implementation
Authors: Warttig S , Elliott N 
Published: August 2013

BackgroundWe were commissioned to partially update a clinical guideline. The remit was to develop new service delivery recommendations to support implementation of the guideline whilst leaving the existing clinical recommendations unchanged.ObjectivesTo describe the approach taken in partially updating a guideline to improve its implementation. To discuss the problems encountered and possible solutions.MethodsAt the time, there was limited guidance on conducting service delivery evidence reviews. A methodology was developed and agreed by the developers, the NICE Methodology Team and the GDG which aimed to ensure the process was as robust, reproducible and transparent as possible.ResultsLimited evidence was identified using the agreed methodology. This prevented identification of successful service delivery models. It also became apparent that that some of the implementation issues were embedded in the original guideline recommendations, and these could not be changed.DiscussionThe methodology used could not adequately address the implementation issues, as it was not possible to amend any of the problematic recommendations, or describe a method of service delivery that was clinically and cost effective. Agreement could not be reached on how to progress with developing the recommendations, and so a decision was made to cease publication of the service delivery recommendations.Implications for Guideline Developers/UsersPartial updates are more challenging for guidelines requiring implementation support and should: 1) Go through a process to assess the issues before deciding how guideline should be updated. Or 2) Come with a remit to enable the developers to amend the recommendations for which implementation support is sought.