- Email: [email protected]
S42– KP Integrated Cardiovascular Disease (CVD) Risk Reduction Guidelines
32
Otolaryngology–Head and Neck Surgery, Vol 143, No 1S1, July 2010
This standard was constructed by the SEARCH group and used as a validation or comparison database to check retrieval properties of filters. Five guideline organizations, CBO, HAS, IUMSP, AQuMed, and INCa, added key references to this database. The tested filters are filters for systematic reviews/ meta-analyses, randomized controlled trials (RCTs), and observational studies. The filters are in use by the guideline organizations in October 2009. Also a consensus filter for each study design, developed during the SEARCH workshop of the GIN conference in Lisboa by participants, was tested. RESULTS: In the validation database 83 references were classified as systematic reviews/meta-analysis. The recall of the tested search filters for this study design ranged from 73% to 100%. As RCTs, 228 references were classified and the recall of filters for RCTs ranged from 94% to 98%. The database contained 207 references classified as observational studies. The recall for this design ranged from 66% to 78%. Looking at the “Lisboa” consensus filter, recall for systematic reviews/meta-analysis was 100%, for RCTs 97%, and for observational studies 77%. DISCUSSION (CONCLUSION): The data show that much can be learned by comparing search methods for retrieval of literature. If guideline organizations use the same methodological search filters, effective and efficient collaboration is promoted. The validation or comparison database offers a tool to use for informed decisions about filter choice. Overall, better retrieval of available strong evidence is considered as important. The SEARCH group has the intention to share many products for information retrieval. TARGET AUDIENCE(S): 1. Evidence synthesizer, developer of systematic reviews or meta-analyses 2. Guideline developer 3. Developer of guideline-based products 4. Quality improvement manager/facilitator 5. Medical educator 6. Allied health professionals 7. Consumers’ and patients’ representatives
S41– Just finished developing a guideline; how did we do? A process evaluation Christa Harstall, MHSA (Presenter) (Institute of Health Economics, Edmonton, Alberta, Canada); Paul Taenzer, PhD (Calgary Pain Program, Calgary, Alberta, Canada); Nancy Zuck, MSc (Sumera Management Consulting, Edmonton, Alberta, Canada); Carmen Moga, MD (Institute of Health Economics, Edmonton, Alberta, Canada); Donna Angus, MHSA (Alberta Innovates - Health Solutions, Edmonton, Alberta, Canada); Ann Scott, PhD (Institute of Health Economics, Edmonton, Alberta, Canada) PRIMARY TRACK: Guideline development SECONDARY TRACK: Guideline development methods
BACKGROUND (INTRODUCTION): The ADAPTE framework outlines a systematic approach for adapting clinical practice guidelines (CPGs) to a local context. The Alberta Health Technology Assessment Ambassador Program melded and contextualized seven ‘seed’ guidelines into one CPG on low back pain. We identified the successful strategies and major challenges associated with the process used to develop the CPG, benchmarked the process with the ADAPTE framework, and identified opportunities for improvement to replicate the process for the next CPG. LEARNING OBJECTIVES (TRAINING GOALS): 1. Identify the successes and challenges of a guideline adaptation program. 2. Describe a framework for evaluating a guideline adaptation process. METHODS: An external consultant developed an Evaluation Framework and used the following data sources: Document review of major program materials and the ADAPTE Framework and Toolkit. Semi-structured telephone interviews conducted with participants of the Ambassador Program Committees. RESULTS: Even though the Alberta health-care system was undergoing major changes we had a response rate of 86% (30/35). There was strong consensus among the stakeholders interviewed that the process used to develop the CPG for low back pain was a sound and rigorous research process. This was primarily due to the following: strong project leadership; multidisciplinary approach; province-wide representation on both the Advisory Committee and Guideline Development Group (GDG); relevance to primary health care; substantial support provided by the Project Team; commitment among all participants to a transparent process; and a quality, evidence-informed product. The process was found to be closely aligned with the ADAPTE framework and included additional enhancements to the quality appraisal tool for the CPGs and the use of the GLIA tool to develop the recommendations and patient input. DISCUSSION (CONCLUSION): All members of the GDG indicated that they would participate in the development of the next CPG. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products
S42– KP Integrated Cardiovascular Disease (CVD) Risk Reduction Guidelines Craig Robbins, MD (Presenter) (Care Management Institute, Kaiser Permanente, Dever, Oregon); Wiley Chan, MD (Kaiser Permanente, Portland, Oregon) PRIMARY TRACK: Guideline development SECONDARY TRACK: Guideline development methods BACKGROUND (INTRODUCTION): In 2008, the Care Management Institute (CMI) at Kaiser Permanente (KP) began
Oral Presentation work on an Integrated Cardiovascular Health (ICVH) initiative that integrates primary prevention, secondary prevention, and treatment for those at risk for cardiovascular disease and those with known coronary artery disease (CAD), diabetes, hypertension, and dyslipidemia. In addition to medication management, lifestyle risk factors such as weight management, tobacco cessation, primary prevention, and reduction of global cardiovascular risk are integrated into this initiative. Over the last several years, the CMI-facilitated KP National Guideline Program (NGP) developed distinct national guidelines for CAD, diabetes, hypertension, and dyslipidemia. Over time, the scope of these individual guidelines increased. In certain cases, clinical recommendations were developed across these guidelines that overlapped, sometimes with conflicting advice. LEARNING OBJECTIVES (TRAINING GOALS): 1. Identify and address opportunities to streamline clinical recommendations across related guidelines. 2. Avoid inconsistency in recommendations across related guidelines. METHODS: In 2009, to address these issues and better support the work of the ICVH initiative, the NGP began work to integrate its cardiovascular guidelines. We assembled a lead team made up of the clinical leads of each of the component guidelines that was charged with oversight and governance of the entire set of ICVH recommendations. RESULTS: The main product will be an Integrated CVD Risk Reduction Guideline. Clinical recommendations from the previous CAD, diabetes, hypertension, and dyslipidemia guidelines that relate to CVD risk reduction will be coordinated and pooled together. The individual guidelines will maintain some unique clinical recommendations. DISCUSSION (CONCLUSION): In the future, the complete CAD, diabetes, and hypertension guidelines will include both the pooled and the unique clinical recommendations. As the project progresses, individual recommendations will be updated as appropriate when new studies are published. We will present our progress to date on integrating these CVD guidelines. TARGET AUDIENCE(S): 1. Guideline developer 2. Developer of guideline-based products 3. Medical providers and executives
S43– Low back interventions and opioid treatment guidelines: Comparison between ACOEM and APS Christopher J. Wolfkiel (Presenter) (ACOEM, Elk Grove Village, Illinois); Julie Ording, MPH (ACOEM, Elk Grove Village, Illinois); Matthew Hughes, MD (University of Utah, Salt Lake City, Utah) PRIMARY TRACK: Guideline development SECONDARY TRACK: Guideline development methods BACKGROUND (INTRODUCTION): Guidelines from the American College of Occupational and Environmental Medicine (ACOEM) and the American Pain Society (APS) on low
33 back interventions and opioid therapy have been recently published. Both sets of guidelines were developed with a similar methodology and found similar quality trials on which to base recommendations. Both methodologies relied on original synthesis of evidence and did not use systematic reviews in developing recommendations. In addition to a defined quality evidence process, ACOEM’s methodology also includes a set of principles which guided panel interpretation of the evidence. These principles generally favor conservative versus invasive treatments in the absence of quality evidence for consensus recommendations. LEARNING OBJECTIVES (TRAINING GOALS): 1. Comparing same topic guidelines of similar methodologies. 2. Assessing the impact of insufficient evidence. METHODS: The ACOEM and APS evidence levels and recommendations were compared. RESULTS: ACOEM and APS generally agreed with evidence levels but had significant recommendation differences in low back interventional therapies, surgery, and interdisciplinary rehabilitation. APS had 16/30 (53%) interventions where insufficient evidence precluded a recommendation; of those, only botulinium injections had a corresponding “No Recommendation,” the rest were “Not Recommended” by ACOEM. APS and ACOEM agreed on “Not Recommending” prolotherapy, intradiscal steroid injection, and facet joint steroid injection. Perhaps most interestingly, APS issued a weak recommendation for fusion surgery in patients with nonradicular pain and common degenerative changes where ACOEM concluded a “Not Recommended” for nonspecific low back pain. DISCUSSION (CONCLUSION): These comparisons suggest that there is a significant potential for recommendation disagreement, especially when evidence is insufficient. Harmonization efforts should take into account value systems in addition to evidence methodologies. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products 4. Health care policy analyst/policymaker 5. Health insurance payers and purchasers 6. Medical providers and executives
S44– Rapid development and implementation of guidelines for infant neuroprotection with antenatal magnesium sulfate (MgSO4) Philippa F. Middleton (Presenter) (The University of Adelaide, North Adelaide, South Australia, Australia); Caroline A. Crowther (The University of Adelaide, North Adelaide, South Australia, Australia); Lex W. Doyle (University of Melbourne, Parkville, Victoria, Australia); Tanya Bubner (The University of Adelaide, North Adelaide, South Australia, Australia); Helena Oakey (The University of Adelaide, North Adelaide, South Australia, Australia); Jonathan Morris (The University of
Otolaryngology–Head and Neck Surgery, Vol 143, No 1S1, July 2010
This standard was constructed by the SEARCH group and used as a validation or comparison database to check retrieval properties of filters. Five guideline organizations, CBO, HAS, IUMSP, AQuMed, and INCa, added key references to this database. The tested filters are filters for systematic reviews/ meta-analyses, randomized controlled trials (RCTs), and observational studies. The filters are in use by the guideline organizations in October 2009. Also a consensus filter for each study design, developed during the SEARCH workshop of the GIN conference in Lisboa by participants, was tested. RESULTS: In the validation database 83 references were classified as systematic reviews/meta-analysis. The recall of the tested search filters for this study design ranged from 73% to 100%. As RCTs, 228 references were classified and the recall of filters for RCTs ranged from 94% to 98%. The database contained 207 references classified as observational studies. The recall for this design ranged from 66% to 78%. Looking at the “Lisboa” consensus filter, recall for systematic reviews/meta-analysis was 100%, for RCTs 97%, and for observational studies 77%. DISCUSSION (CONCLUSION): The data show that much can be learned by comparing search methods for retrieval of literature. If guideline organizations use the same methodological search filters, effective and efficient collaboration is promoted. The validation or comparison database offers a tool to use for informed decisions about filter choice. Overall, better retrieval of available strong evidence is considered as important. The SEARCH group has the intention to share many products for information retrieval. TARGET AUDIENCE(S): 1. Evidence synthesizer, developer of systematic reviews or meta-analyses 2. Guideline developer 3. Developer of guideline-based products 4. Quality improvement manager/facilitator 5. Medical educator 6. Allied health professionals 7. Consumers’ and patients’ representatives
S41– Just finished developing a guideline; how did we do? A process evaluation Christa Harstall, MHSA (Presenter) (Institute of Health Economics, Edmonton, Alberta, Canada); Paul Taenzer, PhD (Calgary Pain Program, Calgary, Alberta, Canada); Nancy Zuck, MSc (Sumera Management Consulting, Edmonton, Alberta, Canada); Carmen Moga, MD (Institute of Health Economics, Edmonton, Alberta, Canada); Donna Angus, MHSA (Alberta Innovates - Health Solutions, Edmonton, Alberta, Canada); Ann Scott, PhD (Institute of Health Economics, Edmonton, Alberta, Canada) PRIMARY TRACK: Guideline development SECONDARY TRACK: Guideline development methods
BACKGROUND (INTRODUCTION): The ADAPTE framework outlines a systematic approach for adapting clinical practice guidelines (CPGs) to a local context. The Alberta Health Technology Assessment Ambassador Program melded and contextualized seven ‘seed’ guidelines into one CPG on low back pain. We identified the successful strategies and major challenges associated with the process used to develop the CPG, benchmarked the process with the ADAPTE framework, and identified opportunities for improvement to replicate the process for the next CPG. LEARNING OBJECTIVES (TRAINING GOALS): 1. Identify the successes and challenges of a guideline adaptation program. 2. Describe a framework for evaluating a guideline adaptation process. METHODS: An external consultant developed an Evaluation Framework and used the following data sources: Document review of major program materials and the ADAPTE Framework and Toolkit. Semi-structured telephone interviews conducted with participants of the Ambassador Program Committees. RESULTS: Even though the Alberta health-care system was undergoing major changes we had a response rate of 86% (30/35). There was strong consensus among the stakeholders interviewed that the process used to develop the CPG for low back pain was a sound and rigorous research process. This was primarily due to the following: strong project leadership; multidisciplinary approach; province-wide representation on both the Advisory Committee and Guideline Development Group (GDG); relevance to primary health care; substantial support provided by the Project Team; commitment among all participants to a transparent process; and a quality, evidence-informed product. The process was found to be closely aligned with the ADAPTE framework and included additional enhancements to the quality appraisal tool for the CPGs and the use of the GLIA tool to develop the recommendations and patient input. DISCUSSION (CONCLUSION): All members of the GDG indicated that they would participate in the development of the next CPG. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products
S42– KP Integrated Cardiovascular Disease (CVD) Risk Reduction Guidelines Craig Robbins, MD (Presenter) (Care Management Institute, Kaiser Permanente, Dever, Oregon); Wiley Chan, MD (Kaiser Permanente, Portland, Oregon) PRIMARY TRACK: Guideline development SECONDARY TRACK: Guideline development methods BACKGROUND (INTRODUCTION): In 2008, the Care Management Institute (CMI) at Kaiser Permanente (KP) began
Oral Presentation work on an Integrated Cardiovascular Health (ICVH) initiative that integrates primary prevention, secondary prevention, and treatment for those at risk for cardiovascular disease and those with known coronary artery disease (CAD), diabetes, hypertension, and dyslipidemia. In addition to medication management, lifestyle risk factors such as weight management, tobacco cessation, primary prevention, and reduction of global cardiovascular risk are integrated into this initiative. Over the last several years, the CMI-facilitated KP National Guideline Program (NGP) developed distinct national guidelines for CAD, diabetes, hypertension, and dyslipidemia. Over time, the scope of these individual guidelines increased. In certain cases, clinical recommendations were developed across these guidelines that overlapped, sometimes with conflicting advice. LEARNING OBJECTIVES (TRAINING GOALS): 1. Identify and address opportunities to streamline clinical recommendations across related guidelines. 2. Avoid inconsistency in recommendations across related guidelines. METHODS: In 2009, to address these issues and better support the work of the ICVH initiative, the NGP began work to integrate its cardiovascular guidelines. We assembled a lead team made up of the clinical leads of each of the component guidelines that was charged with oversight and governance of the entire set of ICVH recommendations. RESULTS: The main product will be an Integrated CVD Risk Reduction Guideline. Clinical recommendations from the previous CAD, diabetes, hypertension, and dyslipidemia guidelines that relate to CVD risk reduction will be coordinated and pooled together. The individual guidelines will maintain some unique clinical recommendations. DISCUSSION (CONCLUSION): In the future, the complete CAD, diabetes, and hypertension guidelines will include both the pooled and the unique clinical recommendations. As the project progresses, individual recommendations will be updated as appropriate when new studies are published. We will present our progress to date on integrating these CVD guidelines. TARGET AUDIENCE(S): 1. Guideline developer 2. Developer of guideline-based products 3. Medical providers and executives
S43– Low back interventions and opioid treatment guidelines: Comparison between ACOEM and APS Christopher J. Wolfkiel (Presenter) (ACOEM, Elk Grove Village, Illinois); Julie Ording, MPH (ACOEM, Elk Grove Village, Illinois); Matthew Hughes, MD (University of Utah, Salt Lake City, Utah) PRIMARY TRACK: Guideline development SECONDARY TRACK: Guideline development methods BACKGROUND (INTRODUCTION): Guidelines from the American College of Occupational and Environmental Medicine (ACOEM) and the American Pain Society (APS) on low
33 back interventions and opioid therapy have been recently published. Both sets of guidelines were developed with a similar methodology and found similar quality trials on which to base recommendations. Both methodologies relied on original synthesis of evidence and did not use systematic reviews in developing recommendations. In addition to a defined quality evidence process, ACOEM’s methodology also includes a set of principles which guided panel interpretation of the evidence. These principles generally favor conservative versus invasive treatments in the absence of quality evidence for consensus recommendations. LEARNING OBJECTIVES (TRAINING GOALS): 1. Comparing same topic guidelines of similar methodologies. 2. Assessing the impact of insufficient evidence. METHODS: The ACOEM and APS evidence levels and recommendations were compared. RESULTS: ACOEM and APS generally agreed with evidence levels but had significant recommendation differences in low back interventional therapies, surgery, and interdisciplinary rehabilitation. APS had 16/30 (53%) interventions where insufficient evidence precluded a recommendation; of those, only botulinium injections had a corresponding “No Recommendation,” the rest were “Not Recommended” by ACOEM. APS and ACOEM agreed on “Not Recommending” prolotherapy, intradiscal steroid injection, and facet joint steroid injection. Perhaps most interestingly, APS issued a weak recommendation for fusion surgery in patients with nonradicular pain and common degenerative changes where ACOEM concluded a “Not Recommended” for nonspecific low back pain. DISCUSSION (CONCLUSION): These comparisons suggest that there is a significant potential for recommendation disagreement, especially when evidence is insufficient. Harmonization efforts should take into account value systems in addition to evidence methodologies. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products 4. Health care policy analyst/policymaker 5. Health insurance payers and purchasers 6. Medical providers and executives
S44– Rapid development and implementation of guidelines for infant neuroprotection with antenatal magnesium sulfate (MgSO4) Philippa F. Middleton (Presenter) (The University of Adelaide, North Adelaide, South Australia, Australia); Caroline A. Crowther (The University of Adelaide, North Adelaide, South Australia, Australia); Lex W. Doyle (University of Melbourne, Parkville, Victoria, Australia); Tanya Bubner (The University of Adelaide, North Adelaide, South Australia, Australia); Helena Oakey (The University of Adelaide, North Adelaide, South Australia, Australia); Jonathan Morris (The University of