The Canadian Congenital Diaphragmatic Hernia Collaborative Mobile App: A National Guideline Implementation Strategy

Abstract

Objective Coinciding with the publication of the Canadian congenital diaphragmatic hernia (CDH) Collaborative's clinical practice guidelines (CPG), we developed a mobile smartphone app to increase guideline utilization and promote knowledge translation. Study Design This mobile app was organized into sections corresponding to the phases of CDH care (prenatal, perinatal/postnatal, and child/adolescent), and contained 22 recommendations supported by evidence summaries, PubMed links, levels of evidence, and strength of expert consensus. Download statistics were collected from September 2018 to June 2020 after release of two iOS versions and an Android platform. Data regarding user numbers/location, most visited sections, and individual session details were analyzed. Results During the study period, the CDH app had 1,586 users predominantly from Canada (40%), United States (30%), and Brazil (12%). The Android release increased app visibility, particularly in Brazil, which had the largest number of new users. Of 3,723 sessions, roughly one-third were returning users. The average session duration and screens viewed/session was 4 minutes and seven screens, respectively. Postnatal ventilation was the most frequently visited subsection after prenatal diagnosis/risk stratification. Measurement of observed-to-expected lung head ratio was the most visited individual recommendation. The guideline compliance checklist was the most frequently accessed resource highlighting its utility. Conclusion The CDH app is an innovative platform to disseminate guidelines. The increasing global reach of the app suggests worldwide CPG relevance. With additional features planned, the CDH app will continue to support clinical decision-making and empower patients and families as they navigate the short and long-term challenges associated with CDH. Key Points

Role of practice standardization in outcome optimization for CDH

“…As part of a modern uptake and implementation strategy following the publication of the CCC guidelines, a smartphone app was developed to allow for ‘fingertip access’ to the guidelines, with the ability to easily update recommendations as new evidence became available. 62 In addition to the recommendations published in the CPG, the app offers additional support features and resources, such as neonatal intensive care rounding checklists and the American Association of Pediatrics long-term CDH surveillance schedule, 63 in addition to links to risk stratification calculators. Finally, a risk calculator was also created for the CDH Study Group clinical prediction rule, stratifying infants into mortality risk categories based on prenatal indices.…”

“…Finally, a risk calculator was also created for the CDH Study Group clinical prediction rule, stratifying infants into mortality risk categories based on prenatal indices. 62 In response to readiness survey comments regarding the need for regular compliance assessments to ensure widespread guideline uptake and utilization, 61 a quality improvement tool for tracking institutional compliance with the guidelines was designed and included as a resource within the mobile app. 62 The app has been used globally, with the majority of users in Canada, followed by the USA, and subsequently Brazil.…”

Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative

“…Leveraging national, interdisciplinary expertise and the best available evidence, this guideline reflected a pragmatic approach to optimal CDH management that sought to minimise variations in care. In order to further increase the guideline’s uptake and utilisation, we developed a free smartphone application providing ready access to CDH care recommendations and the evidence that informed them 2. Knowledge synthesis related to care of CDH has been ongoing since 2018, and an update that assimilates recent best evidence using a rigorous appraisal methodology is timely.…”