Bridging the Guideline Implementation Gap: A Systematic, Document-Centered Approach to Guideline Implementation

Shiffman, Richard N.; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth

doi:10.1197/jamia.m1444

Cited by 159 publications

(113 citation statements)

References 21 publications

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“…In an attempt to standardize care and improve patient outcomes [3], asthma clinical practice guidelines (CPGs) have been developed by national bodies [4,5], however their clinical use is limited. This may be attributed to several problems common to CPGs developed for other clinical conditions, including their availability in a paper format that requires translation into a computer readable format [6] for better integration with a clinical workflow, and the need for customization to site-specific characteristics -this task alone constitutes up to 90% of the total implementation effort [7].…”

Section: Introductionmentioning

confidence: 99%

Implementing an Integrative Multi-agent Clinical Decision Support System with Open Source Software

et al. 2010

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This paper describes the development of a tree-based decision model to predict the severity of pediatric asthma exacerbations in the emergency department (ED) at two hours following triage. The model was constructed from retrospective patient data abstracted from the ED charts. The original data was preprocessed to eliminate questionable patient records and to normalize values of age-dependent clinical attributes. The model uses attributes routinely collected in the ED and provides predictions even for incomplete observations. Its performance was verified on independent validating data (split-sample validation) where it demonstrated AUC (area under ROC curve) of 0.83, sensitivity of 84%, specificity of 71% and the Brier score of 0.18. The model is intended to supplement an asthma clinical practice guideline, however, it can be also used as a stand-alone decision tool.

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Section: Introductionmentioning

confidence: 99%

Implementing an Integrative Multi-agent Clinical Decision Support System with Open Source Software

et al. 2010

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“…In seeking to increase evidence-based policy and practice, scholars (Conroy and Shannon 1995;Picken et al 1998;Shiffman et al 2004;Grimshaw and Grol, 2001) have focused on the requirement for fidelity to guideline implementation (Keith et al 2010) and accumulating knowledge around the variables that impact the adoption and implementation of evidence into practice.…”

Section: Top Down Strategymentioning

confidence: 99%

Policy translation through localisation: implementing national policy in the UK

Sausman

Oborn

Barrett

2016

Policy &Amp; Politics

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This paper builds on policy implementation studies, which seek to explain how policies undergo some form of ‘translation’ from general policy guidelines to implementation in practice at the local level. The paper makes two contributions to the policy implementation literature. First, it draws on the concept of ‘local universality’ to suggest that the translation of policy by central actors is not simply transmitted but is iteratively transformed through multiple distributed agencies including local actors, infrastructure, data sets and organisational practices. Second, empirical findings show how structural policy design features influence implementation and (re)shape policy content by incorporating knowledge from practice.

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“…16 The motivation behind guideline representation work is that, if guidelines can be encoded in a standard way, then multiple different systems can automate the guidelines at the point of care with minimal custom programming. 17,18 Pediatricians are involved in this work 17,19 and in the area of standard approaches to guideline evaluation. 20 Error Reporting Error reporting can make care safer if reporting can be performed as a byproduct of care and not as part of the typical "incident report" process.…”

Section: Guideline Deploymentmentioning

confidence: 99%

Data Standards and Improvement of Quality and Safety in Child Health Care

Spooner

Classen

2009

Pediatrics

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Progress in using information technology to achieve the goal of high-quality health care is hindered by the lack of coordinated data standards. To accelerate quality improvement in pediatrics, child health providers must participate actively in the creation of health care data standards. To do so will require far greater understanding on the part of pediatricians and other pediatric providers regarding the scope and role of data standards in advancing health information systems for children, as well as how data standards could improve quality in child health, what kinds of data standards hold the most promise for quality improvement in child health, and how child health professionals can engage in the work of creating data standards. Child health professionals in organized and academic medicine should participate in standards development organizations, to present the pediatric point of view as data standards emerge. They also should support efforts to certify electronic health record systems that include pediatric functionality. A major challenge to academic pediatrics is to prove that data standards can lead to improved health outcomes for children; this is only a compelling conjecture as of this writing. Pediatrics 2009;123:S74-S79 T HE INSTITUTE OF Medicine specifies 6 attributes of quality in health care, namely, safety, effectiveness, patient-centeredness, timeliness, efficiency, and equitability. 1 The medical community broadly accepts that information technology (IT) and health care information systems will play an important role in implementing and measuring these quality attributes. 2,3 Progress in using IT to achieve these ends is hindered, however, by the lack of coordinated data standards. 4 To accelerate quality improvement in pediatrics, child health providers must participate actively in the creation of health care data standards. In this report, we describe how data standards could improve quality in child health, what kinds of data standards hold the most promise for quality improvement in child health, and how child health professionals can engage in the work of creating data standards. TYPES OF HEALTH CARE DATA STANDARDSStandards exist to allow people in different roles or in different institutions to cooperate efficiently and effectively. For example, because electrical outlets in a given country are standardized, different manufacturers can produce appliances that work in every home. In health care, a standard definition of acute lymphoblastic leukemia assists practitioners in providing similar care to patients in different health care facilities. Time and energy do not need to be expended in converting electrical plugs or redefining acute lymphoblastic leukemia staging, because these standards have been accepted by a wide range of individuals.There are 3 types of data standards that influence health care IT, that is, terminology standards, messaging standards, and functional standards. Terminology standards specify which terms are to be used in a particular clinical domain and how e...

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Bridging the Guideline Implementation Gap: A Systematic, Document-Centered Approach to Guideline Implementation

Abstract: Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge.

Cited by 159 publications

References 21 publications

Implementing an Integrative Multi-agent Clinical Decision Support System with Open Source Software

Implementing an Integrative Multi-agent Clinical Decision Support System with Open Source Software

Policy translation through localisation: implementing national policy in the UK

Data Standards and Improvement of Quality and Safety in Child Health Care

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