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S59– A framework to improve guidelines for patients with multimorbidity
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Otolaryngology–Head and Neck Surgery, Vol 143, No 1S1, July 2010
meta-ethnography may be a powerful tool for knowledge transfer. TARGET AUDIENCE(S): 1. Evidence synthesizer, developer of systematic reviews or meta-analyses 2. Guideline developer
S59– A framework to improve guidelines for patients with multimorbidity Cynthia Boyd, MD (Presenter) (Johns Hopkins, Towson, Maryland); Bruce Leff, MD (Johns Hopkins, Baltimore, Maryland); David Kent, MD (Tufts Medical Center, Boston, Massachusetts); Katrin Uhlig, MD (Tufts Medical Center, Boston, Massachusetts) PRIMARY TRACK: Guideline development SECONDARY TRACK: Guidelines for patients with multiple comorbidities BACKGROUND (INTRODUCTION): Current guideline development approaches do not prompt guideline developers to routinely consider to what degree patients with relevant comorbidity benefit similarly from a particular therapy, and do not provide tools for adapting recommendations to the comorbid patient or for prioritizing the most important recommendations within a single disease, let alone between diseases. LEARNING OBJECTIVES (TRAINING GOALS): 1. Understand how multimorbidity is relevant to guideline development and consumers. 2. Identify issues related to people with multimorbidity that should be considered in the development of a guideline. METHODS: A collaborative team with expertise along the continuum of medical research–from study and clinical trial design to systematic review to guideline development– generated a list of issues relevant for addressing multimorbidity at each step of guideline development. An external expert panel provided feedback on these issues. RESULTS: The issues relevant for addressing multimorbidity include the following examples, organized by guideline development processes: ● in topic selection, including relevant comorbid conditions when defining the population of interest; ● in work group processes, including guideline work group members and reviewers with expertise on the relevant comorbidity; ● in choosing outcomes and ranking their importance, incorporating values and judgments of patients with relevant comorbidity; ● in setting study criteria, explicitly choosing between the trade-offs of study designs with greater internal versus external validity; ● in searches, finding evidence on subgroups or interactions; ● in evidence appraisal, considering the time horizon relevant to persons with comorbid conditions;
in quality appraisal, considering impact of comorbidity on quality of the evidence (in particular directness); and ● in formulation of recommendations, considering how the presence of comorbidity impacts on the balance of benefits and harms and the strength of a recommendation. DISCUSSION (CONCLUSION): Future work of this grant focuses on developing a prioritized set of recommendations to prompt guideline developers to make guidelines more directly applicable to the patient with multimorbidity. TARGET AUDIENCE(S): 1. Clinical researcher 2. Evidence synthesizer, developer of systematic reviews or meta-analyses 3. Guideline developer 4. Guideline implementer 5. Developer of guideline-based products 6. Health care policy analyst/policymaker 7. Medical providers and executives 8. Consumers’ and patients’ representatives ●
S60– Clinical practice guidelines production and its correlation with developmental status of countries: Analysis in Iberoamerican countries In˜aki Gutie´rrez-Ibarluzea, PhD (Presenter) (Osteba Basque Office for HTA, Vitoria-Gasteiz, Araba/ Basque Country, Spain); Mª Asun Navarro-Puerto, MD (Andalucian Health Service, Sevilla, Spain); Mª Eugenia Esandi, PhD (National Academy of Medicine, Buenos Aires, Buenos Aires, Argentina) PRIMARY TRACK: Guideline development SECONDARY TRACK: Guidelines in developing countries BACKGROUND (INTRODUCTION): Clinical practice guideline (CPG) production has been increasing in Iberoamerican countries. In some countries CPG production has been related to governmental and/or scientific societies’ initiatives. Nevertheless, it has not been homogeneous in the Iberoamerican context. In fact, some countries have established initiatives and clearinghouses while others depend on nongovernmental initiatives. LEARNING OBJECTIVES (TRAINING GOALS): 1. To map and catalogue the CPGs produced in different Iberoamerican countries and its correlation with the gross domestic product of those countries. 2. To compare the characteristics of those CPGs and the sources where they are identified. METHODS: We performed a systematic bibliographic and complementary hand-search in: EMBASE, Medline, Lilacs, and IME; CPG clearinghouses (NGC, GIN, Guiasalud), and potential producers. We included CPGs produced in Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Portugal, and Spain that could be recovered in full-text format (period 19952005). Final CPGs were independently selected by two reviewers on the basis of CPG definition accepted by GIN.
Otolaryngology–Head and Neck Surgery, Vol 143, No 1S1, July 2010
meta-ethnography may be a powerful tool for knowledge transfer. TARGET AUDIENCE(S): 1. Evidence synthesizer, developer of systematic reviews or meta-analyses 2. Guideline developer
S59– A framework to improve guidelines for patients with multimorbidity Cynthia Boyd, MD (Presenter) (Johns Hopkins, Towson, Maryland); Bruce Leff, MD (Johns Hopkins, Baltimore, Maryland); David Kent, MD (Tufts Medical Center, Boston, Massachusetts); Katrin Uhlig, MD (Tufts Medical Center, Boston, Massachusetts) PRIMARY TRACK: Guideline development SECONDARY TRACK: Guidelines for patients with multiple comorbidities BACKGROUND (INTRODUCTION): Current guideline development approaches do not prompt guideline developers to routinely consider to what degree patients with relevant comorbidity benefit similarly from a particular therapy, and do not provide tools for adapting recommendations to the comorbid patient or for prioritizing the most important recommendations within a single disease, let alone between diseases. LEARNING OBJECTIVES (TRAINING GOALS): 1. Understand how multimorbidity is relevant to guideline development and consumers. 2. Identify issues related to people with multimorbidity that should be considered in the development of a guideline. METHODS: A collaborative team with expertise along the continuum of medical research–from study and clinical trial design to systematic review to guideline development– generated a list of issues relevant for addressing multimorbidity at each step of guideline development. An external expert panel provided feedback on these issues. RESULTS: The issues relevant for addressing multimorbidity include the following examples, organized by guideline development processes: ● in topic selection, including relevant comorbid conditions when defining the population of interest; ● in work group processes, including guideline work group members and reviewers with expertise on the relevant comorbidity; ● in choosing outcomes and ranking their importance, incorporating values and judgments of patients with relevant comorbidity; ● in setting study criteria, explicitly choosing between the trade-offs of study designs with greater internal versus external validity; ● in searches, finding evidence on subgroups or interactions; ● in evidence appraisal, considering the time horizon relevant to persons with comorbid conditions;
in quality appraisal, considering impact of comorbidity on quality of the evidence (in particular directness); and ● in formulation of recommendations, considering how the presence of comorbidity impacts on the balance of benefits and harms and the strength of a recommendation. DISCUSSION (CONCLUSION): Future work of this grant focuses on developing a prioritized set of recommendations to prompt guideline developers to make guidelines more directly applicable to the patient with multimorbidity. TARGET AUDIENCE(S): 1. Clinical researcher 2. Evidence synthesizer, developer of systematic reviews or meta-analyses 3. Guideline developer 4. Guideline implementer 5. Developer of guideline-based products 6. Health care policy analyst/policymaker 7. Medical providers and executives 8. Consumers’ and patients’ representatives ●
S60– Clinical practice guidelines production and its correlation with developmental status of countries: Analysis in Iberoamerican countries In˜aki Gutie´rrez-Ibarluzea, PhD (Presenter) (Osteba Basque Office for HTA, Vitoria-Gasteiz, Araba/ Basque Country, Spain); Mª Asun Navarro-Puerto, MD (Andalucian Health Service, Sevilla, Spain); Mª Eugenia Esandi, PhD (National Academy of Medicine, Buenos Aires, Buenos Aires, Argentina) PRIMARY TRACK: Guideline development SECONDARY TRACK: Guidelines in developing countries BACKGROUND (INTRODUCTION): Clinical practice guideline (CPG) production has been increasing in Iberoamerican countries. In some countries CPG production has been related to governmental and/or scientific societies’ initiatives. Nevertheless, it has not been homogeneous in the Iberoamerican context. In fact, some countries have established initiatives and clearinghouses while others depend on nongovernmental initiatives. LEARNING OBJECTIVES (TRAINING GOALS): 1. To map and catalogue the CPGs produced in different Iberoamerican countries and its correlation with the gross domestic product of those countries. 2. To compare the characteristics of those CPGs and the sources where they are identified. METHODS: We performed a systematic bibliographic and complementary hand-search in: EMBASE, Medline, Lilacs, and IME; CPG clearinghouses (NGC, GIN, Guiasalud), and potential producers. We included CPGs produced in Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Portugal, and Spain that could be recovered in full-text format (period 19952005). Final CPGs were independently selected by two reviewers on the basis of CPG definition accepted by GIN.