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5 step adaptation process

The different steps of making a guideline
by

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
Taxonomy
Modifications?
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
updated
evidence

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:
Exclusion?
Population,
Intervention or
Comparator
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
Librarians
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:
Feasibility
PICO element
Documentation
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