Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2005 Jul 27:5:23.
doi: 10.1186/1472-6947-5-23.

The GuideLine Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation

Richard N Shiffman  1 , Jane Dixon, Cynthia Brandt, Abdelwaheb Essaihi, Allen Hsiao, George Michel, Ryan O'Connell
Affiliations

The GuideLine Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation

Richard N Shiffman et al. BMC Med Inform Decis Mak. .

Abstract

Background: Clinical practice guidelines are not uniformly successful in influencing clinicians' behaviour toward best practices. Implementability refers to a set of characteristics that predict ease of (and obstacles to) guideline implementation. Our objective is to develop and validate a tool for appraisal of implementability of clinical guidelines.

Methods: Indicators of implementability were identified from the literature and used to create items and dimensions of the GuideLine Implementability Appraisal (GLIA). GLIA consists of 31 items, arranged into 10 dimensions. Questions from 9 of the 10 dimensions are applied individually to each recommendation of the guideline. Decidability and Executability are critical dimensions. Other dimensions are Global, Presentation and Formatting, Measurable Outcomes, Apparent Validity, Flexibility, Effect on Process of Care, Novelty/Innovation, and Computability. We conducted a series of validation activities, including validation of the construct of implementability, expert review of content for clarity, relevance, and comprehensiveness, and assessment of construct validity of the instrument. Finally, GLIA was applied to a draft guideline under development by national professional societies.

Results: Evidence of content validity and preliminary support for construct validity were obtained. The GLIA proved to be useful in identifying barriers to implementation in the draft guideline and the guideline was revised accordingly.

Conclusion: GLIA may be useful to guideline developers who can apply the results to remedy defects in their guidelines. Likewise, guideline implementers may use GLIA to select implementable recommendations and to devise implementation strategies that address identified barriers. By aiding the design and operationalization of highly implementable guidelines, our goal is that application of GLIA may help to improve health outcomes, but further evaluation will be required to support this potential benefit.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Example of a GLIA Summary Report on draft recommendations from a guideline for diagnosis and management of otitis media with effusion.
See this image and copyright information in PMC

References

    1. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8:1–72. Review. - PubMed
    1. Larson E. Status of practice guidelines in the United States: CDC guidelines as an example. [Review] [64 refs] Preventive Medicine. 2003;36:519–524. doi: 10.1016/S0091-7435(03)00014-8. - DOI - PubMed
    1. Burgers JS, Grol R, Klazinga NS, Makela M, Zaat J, AGREE Collaboration Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual Health Care. 2003;15:31–45. doi: 10.1093/intqhc/15.1.31. - DOI - PubMed
    1. Eccles M, McColl E, Steen N, Rousseau N, Grimshaw J, Parkin D. Effect of computerised evidence-based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial. BMJ. 2002;325:941–948. doi: 10.1136/bmj.325.7370.941. - DOI - PMC - PubMed
    1. Tierney WM, Overhage JM, Murray MD, Harris LE, Zhou XH, Eckert GJ, Smith FE, Nienaber N, McDonald CJ, Wolinsky FD. Effects of computerized guidelines for managing heart disease in primary care. J Gen Intern Med. 2003;18:967–976. doi: 10.1111/j.1525-1497.2003.30635.x. - DOI - PMC - PubMed

Publication types

LinkOut - more resources