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. 2023 Sep-Oct;38(5S Suppl 2):S12-S34.
doi: 10.1097/JMQ.0000000000000137. Epub 2023 Sep 5.

An Integrated Process for Co-Developing and Implementing Written and Computable Clinical Practice Guidelines

Dyann M Matson-Koffman  1 , Susan J Robinson  1 , Priya Jakhmola  1 , Laura J Fochtmann  2 , DuWayne Willett  3 , Ira M Lubin  1 , Matthew M Burton  4 , Amrita Tailor  1 , Dana L Pitts  1 , Donald E Casey Jr  5 , Frank G Opelka  6 , Ryan Mullins  7 , Randy Elder  1 , Maria Michaels  1
Affiliations

An Integrated Process for Co-Developing and Implementing Written and Computable Clinical Practice Guidelines

Dyann M Matson-Koffman et al. Am J Med Qual. 2023 Sep-Oct.

Abstract

The goal of this article is to describe an integrated parallel process for the co-development of written and computable clinical practice guidelines (CPGs) to accelerate adoption and increase the impact of guideline recommendations in clinical practice. From February 2018 through December 2021, interdisciplinary work groups were formed after an initial Kaizen event and using expert consensus and available literature, produced a 12-phase integrated process (IP). The IP includes activities, resources, and iterative feedback loops for developing, implementing, disseminating, communicating, and evaluating CPGs. The IP incorporates guideline standards and informatics practices and clarifies how informaticians, implementers, health communicators, evaluators, and clinicians can help guideline developers throughout the development and implementation cycle to effectively co-develop written and computable guidelines. More efficient processes are essential to create actionable CPGs, disseminate and communicate recommendations to clinical end users, and evaluate CPG performance. Pilot testing is underway to determine how this IP expedites the implementation of CPGs into clinical practice and improves guideline uptake and health outcomes.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Overview of Integrated Process for Developing Written and Computable Guidelines. Red italicized font represents informatic activities. Can be at local levels (eg, a single hospital system), regional level (eg, a large group practice in a particular state), or beyond (using shared resources, such as a computable guideline’s repository). COMM, communication; Dev Topic, development; EVAL, evaluation; INFO, informatics; IMPL *, implementation*; SME, subject matter expert; Subj, subject.
Figure 2.
Figure 2.
Semi-structured version of the 2015 US Prevention Service Task Force full recommendation statement for Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus. This is a direct example from the US Prevention Service Task Force. Additional inclusion criteria outlined in this decision log are included in the section titled “Patient Population Under Consideration” of the full recommendation statement.,
Figure 3.
Figure 3.
Excerpt of computable diabetes screening recommendation
Figure 4.
Figure 4.
Example of a consumer guide fact sheet disseminated for the diabetes recommendation. Archived: Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org).
Figure 5.
Figure 5.
Example of computable diabetes recommendation implemented in a provider-facing CDS.
Figure 6.
Figure 6.
Example of computable diabetes recommendation implemented in a patient-facing CDS mobile app.
Figure 7.
Figure 7.
A 12-Phase integrated process for developing and implementing clinical practice guidelines.
See this image and copyright information in PMC

References

    1. Alper BS, Hand JA, Elliott SG, et al. . How much effort is needed to keep up with the literature relevant for primary care? J Med Libr Assoc. 2004;92:429–437. - PMC - PubMed
    1. Institute of Medicine. Clinical Practice Guidelines We Can Trust. National Academies Press; 2011. - PubMed
    1. Dufour JC, Bouvenot J, Ambrosi P, et al. . Textual guidelines versus computable guidelines: a comparative study in the framework of the PRESGUID project in order to appreciate the impact of guideline format on physician compliance. AMIA Annu Symp Proc. 2006;2006:219–223. - PMC - PubMed
    1. Fox J, Patkar V, Chronakis I, et al. . From practice guidelines to clinical decision support: closing the loop. J R Soc Med. 2009;102:464–473. - PMC - PubMed
    1. Bierbaum M, Rapport F, Arnolda G, et al. . Clinicians’ attitudes and perceived barriers and facilitators to cancer treatment clinical practice guideline adherence: a systematic review of qualitative and quantitative literature. Implement Sci. 2020;15:39. - PMC - PubMed