scholarly journals Mind the gap: Mapping Variation between National and Local Clinical Practice Guidelines for Acute Paediatric Asthma from the United Kingdom and the Netherlands

2021 ◽  
Author(s):  
Charlotte Koldeweij ◽  
Jonathan Clarke ◽  
Carmen Rodriguez Gonzalvez ◽  
Joppe Nijman ◽  
Ruchi Sinha ◽  
...  
Keyword(s):  
United Kingdom ◽  
Clinical Practice ◽  
The Netherlands ◽  
Severe Asthma ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Care ◽  
Paediatric Asthma ◽  
The United Kingdom ◽  
National Guidance

Background: Clinical practice guidelines (CPGs) aim to standardize clinical care. Increasingly, hospitals rely on locally produced guidelines alongside national guidance. This study examines variation between national and local CPGs, using the example of acute paediatric asthma guidance from the United Kingdom and the Netherlands. Methods: Fifteen British and Dutch local CPGs were collected with the matching national guidance for the management of acute asthma in children under 18 years old. The drug sequences, routes and methods of administration recommended for patients with severe asthma and the tone of recommendation across both types of CPGs were schematically represented. Deviations from national guidance were measured. Variation in recommended doses of intravenous salbutamol was examined. Results: British and Dutch national CPGs differed in the recommended drug choices, sequences, routes and methods of administration for severe asthma. Dutch national guidance was more rigidly defined. Local British CPGs diverged from national guidance for 23% of their recommended interventions compared to 8% for Dutch local CPGs. Five British local guidelines and two Dutch local guidelines differed from national guidance for multiple treatment steps. Variation in second-line recommendations was greater than for first-line recommendations across local CPGs from both countries. Recommended starting doses for salbutamol infusions varied by more than tenfold. Conclusions: Local CPGs for the management of severe acute paediatric asthma featured substantial variation and frequently diverged from national guidance. Although limited to one condition, this study suggests that unmeasured variation across local CPGs may contribute to variation of care more broadly, with possible effects on healthcare quality.

Quality Improvement in Otolaryngology–Head and Neck Surgery: Developing Registry-Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process

2021 ◽  
pp. 019459982110119
Author(s):  
Jeremy J. Michel ◽  
Seth R. Schwartz ◽  
Douglas E. Dawson ◽  
James C. Denneny ◽  
Eileen Erinoff ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Practice ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Care ◽  
Quality Measures ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Quality Reporting

Background and Significance Quality measurement can drive improvement in clinical care and allow for easy reporting of quality care by clinicians, but creating quality measures is a time-consuming and costly process. ECRI (formerly Emergency Care Research Institute) has pioneered a process to support systematic translation of clinical practice guidelines into electronic quality measures using a transparent and reproducible pathway. This process could be used to augment or support the development of electronic quality measures of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) and others as the Centers for Medicare and Medicaid Services transitions from the Merit-Based Incentive Payment System (MIPS) to the MIPS Value Pathways for quality reporting. Methods We used a transparent and reproducible process to create electronic quality measures based on recommendations from 2 AAO-HNSF clinical practice guidelines (cerumen impaction and allergic rhinitis). Steps of this process include source material review, electronic content extraction, logic development, implementation barrier analysis, content encoding and structuring, and measure formalization. Proposed measures then go through the standard publication process for AAO-HNSF measures. Results The 2 guidelines contained 29 recommendation statements, of which 7 were translated into electronic quality measures and published. Intermediate products of the guideline conversion process facilitated development and were retained to support review, updating, and transparency. Of the 7 initially published quality measures, 6 were approved as 2018 MIPS measures, and 2 continued to demonstrate a gap in care after a year of data collection. Conclusion Developing high-quality, registry-enabled measures from guidelines via a rigorous reproducible process is feasible. The streamlined process was effective in producing quality measures for publication in a timely fashion. Efforts to better identify gaps in care and more quickly recognize recommendations that would not translate well into quality measures could further streamline this process.

Is GRADE the Right Choice for Clinical Practice Guidelines Developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation?

2019 ◽  
Vol 161 (1) ◽  
pp. 3-5
Author(s):  
Andrés M. Bur ◽  
Richard M. Rosenfeld
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Current Knowledge ◽  
Clinical Care ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
The Right

Clinical practice guidelines (CPGs), developed to inform clinicians, patients, and policy makers about what constitutes optimal clinical care, are one way of increasing implementation of evidence into clinical practice. Many factors must be considered by multidisciplinary guideline panels, including strength of available evidence, limitations of current knowledge, risks/benefits of interventions, patient values, and limited resources. Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a framework for summarizing evidence that has been endorsed by many national and international organizations for developing CPGs. But is GRADE the right choice for CPGs developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF)? In this commentary, we will introduce GRADE, discuss its strengths and limitations, and address the question of what potential benefits GRADE might offer beyond existing methodology used by the AAO-HNSF in developing CPGs.

scholarly journals Clinical Guidelines 2.0: Translation of Tables 2 and 3 and Apendix 1 of Schünemann HJ et al. CMAJ. 2014; 186:E123-42.

2015 ◽  
Vol 28 (3) ◽  
pp. 395
Author(s):  
Guilherme Ferreira dos Santos ◽  
Pedro Correia Azevedo ◽  
António Vaz-Carneiro
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Care ◽  
Canadian Medical Association Journal ◽  
Dissemination And Implementation ◽  
Quality Literature ◽  
Intrinsic Quality ◽  
The University ◽  
Based Medicine

<p>Clinical Practice Guidelines are instruments to support decision to improve the quality of clinical care. An expert group from McMaster University (Canada) has developed - from high-quality literature sources – a guidance on the practical steps for their development, dissemination, implementation and evaluation. This is the 1st time anyone seeks to bring together in one document all information regarding the Clinical Practice Guidelines. Due to the interest of this paper, the Centre for Evidence Based Medicine at the University of Lisbon School of Medicine contacted the authors of the article and the journal where it was published (the Canadian Medical Association Journal) in order to translate the most relevant parts of the article (including the practice tables), which was agreed. This guide should be useful to those who, being interested in the development, dissemination and implementation of Clinical Practice Guidelines, want to ensure their intrinsic quality based on relevant and updated evidence.</p>

scholarly journals Investigating the Benefits of Out-of-Hospital External Chest Compression

2015 ◽  
Vol 5 (3) ◽  
Author(s):  
Brett Williams ◽  
Brian Fallows ◽  
Jeff Allan
Keyword(s):  
Clinical Practice ◽  
New Zealand ◽  
Severe Asthma ◽  
Chest Compression ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Status Asthmaticus ◽  
Cochrane Library ◽  
External Chest Compression ◽  
Lateral Chest

Introduction 1. To review and analyse the literature regarding out-of-hospital external chest compressions (ECC) in severe asthma and status asthmaticus. 2. To compare which ambulance services in Australia and New Zealand actively use ECC in their clinical practice guidelines for severe asthma. Methods Literature review using a variety of medical databases including, Medline, AMED, ProQuest, EMBASE, CINAHL, Scopus and Cochrane Library from 1950 to present. The following keywords were used in the search strategy, ambulance, asthma, emergency medical technicians, external chest compression, external chest pressure, lateral chest compression, lateral chest pressure, out-of-hospital, paramedic, prehospital, status asthmaticus and thoracic compression. A review of Australian and New Zealand ambulance service clinical practice guidelines was also undertaken comparing the current out-of-hospital guidelines use of ECC. Results A total of nine papers were located with low levels of evidence supporting the use of ECC. Only two papers directly discussed ECC in the context of out-of-hospital care. Three of the eight Australian ambulance services actively use ECC in their clinical practice guidelines. Conclusion High level evidence was not found supporting the use of ECC in severe asthma or status asthmaticus. Anecdotal opinions and case reports generally have supported its use in dynamic hyperinflation settings. Further research is required before recommendations can be made.

Implementation of clinical practice guidelines in a multicenter radiation oncology department.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 117-117
Author(s):  
Sewit Teckie ◽  
Lucille Lee ◽  
Henry Chou ◽  
Petrina Zuvic ◽  
Louis Potters
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Radiation Oncology ◽  
Cancer Care ◽  
Clinical Care ◽  
Care Process ◽  
Standards Of Care ◽  
Cancer Site ◽  
Evidence Based

117 Background: Recent reports suggest that less than 20% of cancer care is based upon level I evidence. As a result, the majority of cancer care tends to be ad-hoc. Furthermore, deviations from established standards-of-care are associated with worse clinical outcomes. Systematic and evidence-based approaches to cancer care are widely regarded as an effective way of improving quality and value in oncology, yet their implementation remains broadly circumspect. In our multicenter radiation medicine department, we developed clinical practice guidelines (CPGs) that encourage consistent care in order to minimize variations in patient treatment, outcome, and experience. We hypothesized that CPGs would also improve efficiency, performance, and cost. Methods: We developed a system for prioritizing value in radiation oncology (Smarter Radiation Oncology) comprising three pillars – quality, evidence-based care, and patient experience. We created 87 unique, evidence-based and consensus-driven electronic CPGs that apply to the majority of patients undergoing radiation therapy in our department. Each CPG delineates an evidence-based treatment approach for a specific cancer site and stage, as well as many technical components such as simulation, treatment planning, quality assurance, clinical care requirements and survivorship. Results: Overall compliance to CPGs was >88%. Six-sigma Z-scores indicated improvement in efficiency and compliance. Treatment delays decreased and patients reported more favorable ratings on a variety of measures, including likelihood to recommend, wait times, understanding of treatment, and physician sensitivity. For breast and prostate cancer, adherence to CPG treatment resulted in 20% and 15% average lower costs than standard, non-CPG treatment. Conclusions: We demonstrate that consensus- and evidence-based CPGs can be successfully implemented in a multicenter department, with high adherence rates. CPGs improve safety and reduce costs by minimizing variation and deviations from standards-of-care. In an era of rising cancer spending, CPGs can be expanded beyond radiation oncology to the entire oncologic care process, thereby improving value for all cancer patients.

AGA Clinical Practice Guidelines: Robust, Evidence-Based Tools for Guiding Clinical Care Decisions

2015 ◽  
Vol 149 (2) ◽  
pp. 493-495
Author(s):  
Madelin R. Siedler ◽  
John I. Allen ◽  
Yngve T. Falck-Ytter ◽  
David S. Weinberg
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Care ◽  
Evidence Based ◽  
Robust Evidence
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