Evidence map›Paper›PMID 21426574›Full record

ArticleImplementation science : IS2011

How can we improve guideline use? A conceptual framework of implementability.

Anna R Gagliardi, Melissa C Brouwers, Valerie A Palda, Louise Lemieux-Charles, Jeremy M Grimshaw

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Implementation science : IS, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 201 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
201citing papers in PubMed, 18 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

201 citing papers in PubMed, 18 syntheses or guidelines pooled it.

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  4. Characteristics and quality of clinical practice guidelines for diabetic kidney disease: a systematic review.Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan · 2024
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  18. Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE): 2014 update.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2014
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141 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Anna R GagliardiDepartments of Surgery; and Department of Health Policy, Management and Evaluation; and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. anna.gagliardi@uhnresearch.ca
Melissa C Brouwers
Valerie A Palda
Louise Lemieux-Charles
Jeremy M Grimshaw

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGuidelines continue to be underutilized, and a variety of strategies to improve their use have been suboptimal. Modifying guideline features represents an alternative, but untested way to promote their use. The purpose of this study was to identify and define features that facilitate guideline use, and examine whether and how they are included in current guidelines.

methodsA guideline implementability framework was developed by reviewing the implementation science literature. We then examined whether guidelines included these, or additional implementability elements. Data were extracted from publicly available high quality guidelines reflecting primary and institutional care, reviewed independently by two individuals, who through discussion resolved conflicts, then by the research team.

resultsThe final implementability framework included 22 elements organized in the domains of adaptability, usability, validity, applicability, communicability, accommodation, implementation, and evaluation. Data were extracted from 20 guidelines on the management of diabetes, hypertension, leg ulcer, and heart failure. Most contained a large volume of graded, narrative evidence, and tables featuring complementary clinical information. Few contained additional features that could improve guideline use. These included alternate versions for different users and purposes, summaries of evidence and recommendations, information to facilitate interaction with and involvement of patients, details of resource implications, and instructions on how to locally promote and monitor guideline use. There were no consistent trends by guideline topic.

conclusionsNumerous opportunities were identified by which guidelines could be modified to support various types of decision making by different users. New governance structures may be required to accommodate development of guidelines with these features. Further research is needed to validate the proposed framework of guideline implementability, develop methods for preparing this information, and evaluate how inclusion of this information influences guideline use.

Indexed as

Guideline AdherencePractice Guidelines as TopicDecision MakingDiabetes MellitusHeart FailureHumansHypertensionLeg Ulcer

Identifiers

PMID21426574
PMCPMC3072935

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.