Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Lecture:Putting evidence into practice
Slide content:Appraising a Clinical Practice Guideline (Richards, 2006) Did the developers carry out a comprehensive, reproducible literature search within the last 12 months? Is each of its recommendations both tagged by the level of evidence upon which it is based and linked to a specific citation? Is the guideline applicable in a particular clinical setting? That is, is there High enough burden of illness to warrant use? Adequate belief about the value of interventions and their consequences? Costs and barriers too high for the community? 7
Slide notes:7 How do we appraise a clinical practice guideline? In some ways its easier than appraising, say, a randomized control trial because we have fewer questions to ask. But a clinical practice guideline has many more steps that need to be appraised as opposed to just the major question that you look at in a randomized control trial. If we retrieve a clinical practice guideline and were thinking about putting it into practice, what questions do we ask? Essentially, there are three. The first question is, Did the developers carry out a comprehensive, reproducible literature search within the last twelve months? In other words, are they up-to-date on their topic? If they are looking at diagnosis of a certain type of cancer, for example, or at treatment of diabetes, are they current on the latest evidence? Have they reviewed the literature comprehensively? The second question is whether each of the recommendations is tagged by the level of evidence upon which its based and linked to a specific citation. If the practice guideline makes a recommendation for a test or treatment, what is the level of evidence to support that recommendation? Where can we find the published research? The third question pertains to applicability. Is the guideline applicable in a particular clinical setting? Applicability raises some practical questions. For example, is there a high enough burden of illness to warrant use of the guideline in this particular setting? If the disease occurs rarely, then we probably dont want to go to the trouble of changing workflow and other kinds of actions to implement the guideline. Is there adequate belief among the users of the guideline concerning the value of the interventions and their consequences? Have we convinced those who are going to implement the guideline that its worth doing so? And might the cost and barriers be too high for the community? If a certain type of diagnostic test or treatment is not readily available, might the barriers be too high for implementation, making the use of the guideline somewhat moot?