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CPG ADAPTATION METHODOLOGY
1. KNH Clinical Practice Guidelines
Adaptation Methodology
Jhessie L. Abella, RN, RM, MAN, CPSO, SMRIN
2.
3. Clinical Practice Guidelines
• Clinical guidelines are consensus statements developed to assist in
clinical management decisions.
• Are sponsored or supported by professional associations or
societies, public or private organizations, government agencies,
etc., and include evidence if modified to meet the population
served
• CPG’s are developed on the focus of quality, based on scientific
evidence and the assessment of likely benefits and harms of a
particular treatment
5. CPG’s guide practitioners with:
Questions to ask and physical signs to check
Lab and other studies to request
Assessments of the condition
Treatments to prescribe
Improve healthcare decision making
7. Types of implementation tools used to integrate
guidelines into daily practice and into the patient
care system are:
Clinical pathways/critical pathway/care maps
Clinical protocols
Standardized order sets
Process flow charts
These tools often include automatic triggers for
care according to the guidelines
10. Criteria for Choosing CPG at KNH
The prevalence of the condition and/or burden associated with the condition
Existence of underuse, overuse or misuse of interventions
The likelihood that the guideline will be effective in influencing practice
The existence of relevant good quality evidence-based guidelines
11. CRITERIA STROKE
PERIPHERAL
NEURITIS
POLYNEUROPATHY
MYTHEMIA
GRAVIS
The prevalence of the condition and/or
burden associated with the condition 5 3 4 2
Existence of underuse, overuse or misuse
of interventions 5 3 4 3
The likelihood that the guideline will be
effective in influencing practice 5 4 3 4
The existence of relevant good quality
evidence-based guidelines 5 5 5 4
SUM 20 15 16 13
13. Guideline Adaptation
• Guideline adaptation is the systematic approach to the
endorsement and/or modification of a guideline(s)
produced in one cultural and organizational setting for
application in a different context. Adaptation may be
used as an alternative to de novo guideline development,
e.g., for customizing (an) existing guideline(s) to suit the
local contents
14. ADAPTE Guideline Adaption
Is an international collaboration of researchers, guideline
developers, and guideline implementers who aim to
promote the development and use of CPGs through the
adaptation of existing guidelines.
Our institutional CPG policy is solely based on this toolkit
developed by ADAPTE collaboration.
15.
16. ADAPTE - a systematic approach to
guideline adaptation
Why develop a systematic approach ?
Help ensure the quality and validity of the adapted guideline
Enhance relevance of adapted guideline to the context of use
Encourage confidence in and acceptance of the guidelines by
targeted users
23. Appraisal of Guidelines Research &
Evaluation (AGREE 2 INTRUMENT)
Was developed to address the issue of variability in guideline
quality. To that end, the AGREE instrument is a tool that assesses
the methodological rigour and transparency in which a guideline is
developed.
Domain 1. Scope and Purpose
Domain 2. Stakeholder Involvement
Domain 3. Rigour of Development
Domain 4. Clarity of Presentation
Domain 5. Applicability
Domain 6. Editorial Independence
Domain 1. Scope and Purpose is concerned with the overall aim of the guideline, the specific
health questions, and the target population (items 1-3).
Domain 2. Stakeholder Involvement focuses on the extent to which the guideline was developed
by the appropriate stakeholders and represents the views of its intended users (items 4-6).
Domain 3. Rigour of Development relates to the process used to gather and synthesize the
evidence, the methods to formulate the recommendations, and to update them (items 7-14).
Domain 4. Clarity of Presentation deals with the language, structure, and format of the guideline
(items 15-17).
Domain 5. Applicability pertains to the likely barriers and facilitators to implementation,
strategies to improve uptake, and resource implications of applying the guideline (items 18-21).
Domain 6. Editorial Independence is concerned with the formulation of recommendations not
being unduly biased with competing interests (items 22-23).