Abstract
BackgroundAlthough quality indicators are frequently derived from guidelines, there is a substantial gap in collaboration between the corresponding parties. To optimise workflow, guideline recommendations and quality assurance should be aligned methodologically and practically. Learning from the European Commission Initiative on Breast Cancer (ECIBC), our objective was to bring the key knowledge and most important considerations from both worlds together to inform European Commission future initiatives.MethodsWe undertook several steps to address the problem. First, we conducted a feasibility study that included a survey, interviews and a review of manuals for an integrated guideline and quality assurance (QA) scheme that would support the European Commission. The feasibility study drew from an assessment of the ECIBC experience that followed commonly applied strategies leading to separation of the guideline and QA development processes. Secondly, we used results of a systematic review to inform our understanding of methodologies for integrating guideline and QA development. We then, in a third step, used the findings to prepare an evidence brief and identify key aspects of a methodological framework for integrating guidelines QA through meetings with key informants.ResultsSeven key themes emerged to be taken into account for integrating guidelines and QA schemes: (1) evidence-based integrated guideline and QA frameworks are possible, (2) transparency is key in clearly documenting the source and rationale for quality indicators, (3) intellectual and financial interests should be declared and managed appropriately, (4) selection processes and criteria for quality indicators need further refinement, (5) clear guidance on retirement of quality indicators should be included, (6) risks of an integrated guideline and QA Group can be mitigated, and (7) an extension of the GIN-McMaster Guideline Development Checklist should incorporate QA considerations.DiscussionWe concluded that the work of guideline and QA developers can be integrated under a common methodological framework and we provided key findings and recommendations. These two worlds, that are fundamental to improving health, can both benefit from integration.
Highlights
Quality indicators are frequently derived from guidelines, there is a substantial gap in collaboration between the corresponding parties
Seven key themes emerged to be taken into account for integrating guidelines and quality assurance (QA) schemes: (1) evidence-based integrated guideline and QA frameworks are possible, (2) transparency is key in clearly documenting the source and rationale for quality indicators, (3) intellectual and financial interests should be declared and managed appropriately, (4) selection processes and criteria for quality indicators need further refinement, (5) clear guidance on retirement of quality indicators should be included, (6) risks of an integrated guideline and QA Group can be mitigated, and (7) an extension of the Guidelines International Network (GIN)-McMaster Guideline Development Checklist should incorporate QA considerations
Thematic analysis Seven key themes emerged as key considerations for integrating guideline and QA schemes: (1) evidence-based integrated guideline and QA frameworks are possible, (2) transparency should be used to clearly document the source and rationale for quality indicators, (3) intellectual and financial interests should be declared and managed appropriately, (4) selection processes and criteria for quality indicators need further refining (QIs), (5) clear guidance on retiring QIs should be included, (6) risks of an integrated guideline and QA Group can be mitigated, and (7) an extension of the GIN-McMaster Guideline Development Checklist should be undertaken to incorporate QA considerations
Summary
Quality indicators are frequently derived from guidelines, there is a substantial gap in collaboration between the corresponding parties. Development of guidelines and quality assurance (QA) schemes in health traditionally operate in two different worlds despite the fact that they are both critical, interdependent health improvement processes, designed to ensure that the best possible health recommendations are developed and that the recommended interventions meet the specified quality standards. Too often, these worlds do not connect well resulting in the development of quality indicators that are not linked to recommendations from respective guidelines, or recommendations that are not translated into quality indicators [1, 2]. GRADE has provided guidance to improve the guideline development process in the form of a detailed guideline development checklist [4]
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