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5 step adaptation process
Transcript of 5 step adaptation process
How confident are you in the effect estimates you have found?
Re-write the recommendations as needed
Step 4: Publication
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
Initial individual assessment
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
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
Details a population of low prevalence
As the recommendation is:
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)
Population, Intervention, Comparator, Outcomes
Downgrade when warranted and decide overall confidence in the magnitude of effect
Finally all old and new documentation quality assessed.
Grading of individual outcomes
Balance between benefits & harms/values & preferences
Quality of the evidence
Do I have any conflicts of interest?