Transforming clinical practice guidelines and clinical pathways into fast-and-frugal decision trees to improve clinical care strategies

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.

Download Full-text

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

Otolaryngology ◽

10.1177/0194599819846458 ◽

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.

Download Full-text

Transitioning Clinical Practice Guidelines into the Electronic Health Record through Clinical Pathways

Methods in Molecular Biology - Translational Bioinformatics for Therapeutic Development ◽

10.1007/978-1-0716-0849-4_4 ◽

2020 ◽

pp. 45-59

Author(s):

Sharjeel M. Hooda ◽

Karen K. Fields

Keyword(s):

Clinical Practice ◽

Electronic Health Record ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Clinical Pathways ◽

Health Record ◽

Electronic Health

Download Full-text

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

Acta Médica Portuguesa ◽

10.20344/amp.6602 ◽

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>

Download Full-text

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

10.1101/2021.09.20.21263735 ◽

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.

Download Full-text

Data-Driven Approaches for Developing Clinical Practice Guidelines

Medical Education and Ethics ◽

10.4018/978-1-5225-0978-3.ch059 ◽

2017 ◽

pp. 1307-1323

Author(s):

Yiye Zhang ◽

Rema Padman

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Visual Analytics ◽

Process Mining ◽

Clinical Pathways ◽

Workflow Management ◽

Machine Learning Algorithms ◽

Data Driven ◽

Statistical Process

This chapter discusses clinical practice guidelines (CPGs) and their incorporation into healthcare IT (HIT) applications. CPGs provide guidance on treatment options based on evidence. This chapter provides a brief background on challenges in CPG development and adherence, and offers examples of data-driven approaches to improve usability of CPGs and their applications in HIT. A focus is given to clinical pathways, which translate CPG recommendations into actionable plans for patient management in community practices. Approaches for developing data-driven clinical pathways from electronic health record data are presented, including statistical, process mining, and machine learning algorithms. Further, efforts on using CPGs for decision support through visual analytics, and deployments of CPGs into mobile applications are described. Data-driven approaches can facilitate incorporation of practice-based evidence into CPG development after validation by clinical experts, potentially bridging the gap between available CPGs and changing clinical needs and workflow management.

Download Full-text

Data-Driven Approaches for Developing Clinical Practice Guidelines

Handbook of Research on Healthcare Administration and Management - Advances in Healthcare Information Systems and Administration ◽

10.4018/978-1-5225-0920-2.ch003 ◽

2017 ◽

pp. 30-46 ◽

Cited By ~ 1

Author(s):

Yiye Zhang ◽

Rema Padman

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Visual Analytics ◽

Process Mining ◽

Clinical Pathways ◽

Workflow Management ◽

Machine Learning Algorithms ◽

Data Driven ◽

Statistical Process

This chapter discusses clinical practice guidelines (CPGs) and their incorporation into healthcare IT (HIT) applications. CPGs provide guidance on treatment options based on evidence. This chapter provides a brief background on challenges in CPG development and adherence, and offers examples of data-driven approaches to improve usability of CPGs and their applications in HIT. A focus is given to clinical pathways, which translate CPG recommendations into actionable plans for patient management in community practices. Approaches for developing data-driven clinical pathways from electronic health record data are presented, including statistical, process mining, and machine learning algorithms. Further, efforts on using CPGs for decision support through visual analytics, and deployments of CPGs into mobile applications are described. Data-driven approaches can facilitate incorporation of practice-based evidence into CPG development after validation by clinical experts, potentially bridging the gap between available CPGs and changing clinical needs and workflow management.

Download Full-text