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5 step adaptation process

The different steps of making a guideline

Annette Kristiansen

on 25 March 2014

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Transcript of 5 step adaptation process

Quality Assessment
How confident are you in the effect estimates you have found?
Step 3:
Final modifications

Re-write the recommendations as needed
Step 4: Publication
Adaptation taxonomy
Which recommendations do I wish to
exclude or modify?
Do I need to develop new recommendations?
Organize a final plenary discussion for all controversial recommendations
Submit final draft to the Editorial Committee
Submit for peer review
Give a rationale
for your decisions
Structured, transparent, tailored to GRADE guidelines
Localized recommendations
Globalized evidence
Step 2:
Initial individual assessment
Guideline Panels
Recruit people who are fun and nice to work with (and also have relevant knowledge, ensure geographical diversity and buy-in)
Include people with methodological expertise
Consider patient involvement and/or health economist
Step 1: Planning
Search for best and

Use old and new PICO questions
Limited resources? Consider using pre-appraised databases to limit your search.
Evidence Practice Centers
GRADE centers
Get help
Consider publication through a new user-friendly, multilayered guideline presentation format.
All available through
Establish an Editorial Committee
Define consensus and leadership processes
Identify high-quality GRADE guideline(s) to adapt
Identify and recruit resources and skills
Formally request participation/support from stakeholders/professional organizations relevant to the clinical topic
Appoint editors and panelists
Organize GRADE training session for editors
Plan implementation strategies
Organize start-up conference
Month 1-6
Not applicable
Details a population of low prevalence
Insufficiently documented
Considered redundant
As the recommendation is:
Intervention or
Due to new:
De novo recommendations?
Step 5: Evaluation
& planning for the future

Perform a formal evaluation of the adaptation process
Evaluate the implementation strategies and revise if necessary
Plan for future (dynamic) updating (DYNAM-IT)
Consider generating Decision Aids (SHARE-IT)
Consider implementation in the EHR (PLUGGED-IN)
Month 8-11
Month 7
Month 12
Population, Intervention, Comparator, Outcomes
Downgrade when warranted and decide overall confidence in the magnitude of effect
Finally all old and new documentation quality assessed.
What's next?
Disagreement with:
PICO element
Grading of individual outcomes
Baseline risk
Relative risk
Balance between benefits & harms/values & preferences
Quality of the evidence
Resource issues
Do I have any conflicts of interest?
Full transcript