How can we improve guideline use? A conceptual framework of implementability
How can we improve guideline use? A conceptual framework of implementability
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DOI：
10.1186/1748-5908-6-26
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发表时间：
2011-03-22
影响因子：
7.2
通讯作者：
Grimshaw, Jeremy M.
中科院分区：
文献类型：
--
作者：
Gagliardi, Anna R.;Brouwers, Melissa C.;Grimshaw, Jeremy M.
背景：准则仍然没有得到充分利用，各种改进其使用的战略都不理想。修改指南特性代表了一种替代的、但未经测试的方法来推广它们的使用。本研究的目的是确定和定义的功能，促进指南的使用，并检查它们是否以及如何包括在当前guidelines.Methods：一个指南的可实施性框架，通过审查实施科学文献。然后，我们研究了指导方针是否包括这些或其他可实施性要素。从公开的高质量的指导方针，反映初级和机构的护理，独立审查的两个人，谁通过讨论解决冲突，然后由research team.Results：最终的可实施性框架包括22个元素，组织在域的适应性，可用性，有效性，适用性，可沟通性，住宿，实施和评估。数据来自20个关于糖尿病、高血压、腿部溃疡和心力衰竭管理的指南。大多数包含大量分级的叙述性证据和具有补充临床信息的表格。很少包含可以改进指南使用的附加功能。其中包括针对不同用户和目的的替代版本、证据和建议摘要、促进与患者互动和患者参与的信息、资源影响的详细信息以及如何在当地推广和监测指南使用的说明。有没有一致的趋势，指南topic.Conclusions：许多机会被确定的准则可以修改，以支持不同用户的各种类型的决策。可能需要新的治理结构来适应具有这些特征的准则的制定。需要进一步的研究来验证所提出的指南可实施性框架，制定准备这些信息的方法，并评估这些信息的纳入如何影响指南的使用。
Background: Guidelines continue to be underutilized, and a variety of strategies to improve their use have been suboptimal. Modifying guideline features represents an alternative, but untested way to promote their use. The purpose of this study was to identify and define features that facilitate guideline use, and examine whether and how they are included in current guidelines.Methods: A guideline implementability framework was developed by reviewing the implementation science literature. We then examined whether guidelines included these, or additional implementability elements. Data were extracted from publicly available high quality guidelines reflecting primary and institutional care, reviewed independently by two individuals, who through discussion resolved conflicts, then by the research team.Results: The final implementability framework included 22 elements organized in the domains of adaptability, usability, validity, applicability, communicability, accommodation, implementation, and evaluation. Data were extracted from 20 guidelines on the management of diabetes, hypertension, leg ulcer, and heart failure. Most contained a large volume of graded, narrative evidence, and tables featuring complementary clinical information. Few contained additional features that could improve guideline use. These included alternate versions for different users and purposes, summaries of evidence and recommendations, information to facilitate interaction with and involvement of patients, details of resource implications, and instructions on how to locally promote and monitor guideline use. There were no consistent trends by guideline topic.Conclusions: Numerous opportunities were identified by which guidelines could be modified to support various types of decision making by different users. New governance structures may be required to accommodate development of guidelines with these features. Further research is needed to validate the proposed framework of guideline implementability, develop methods for preparing this information, and evaluate how inclusion of this information influences guideline use.