Gagliardi Anna R, Brouwers Melissa C, Bhattacharyya Onil K
University Health Network, Toronto, ON, Canada.
Implement Sci. 2014 Aug 5;9:98. doi: 10.1186/s13012-014-0098-8.
Guidelines are the foundation for healthcare planning, delivery and quality improvement but are not consistently implemented. Few guidelines are accompanied by guideline implementation tools (GItools). Users have requested GItools, and developers have requested guidance on how to develop GItools. First it is necessary to characterize GItools. The purpose of this research was to generate a framework of desirable features of GItools.
Items representing desirable GItool features were generated by a cross-sectional survey of the international guideline community. Items were confirmed by 31 guideline developers, implementers and researchers in a two-round Delphi survey administered on the Internet. The resulting GItool framework was applied with a sample of GItools accompanying guidelines identified in the National Guideline Clearinghouse.
The cross-sectional survey was completed by 96 respondents from Australia, Canada, the United Kingdom, the United States, The Netherlands, and various other countries. Seven of nine items were rated by the majority as desirable. A total of 31 panelists from 10 countries including Australia, Canada, Germany, New Zealand, Peru, Saudi Arabia, Spain, the United Kingdom, and the United States took part in a two-round Delphi survey. Ten items achieved consensus as desirable GItool features in round #1, and two additional items in round #2. A total of 13 GItools for Resource Planning, Implementation and Evaluation were identified among 149 guidelines on a variety of clinical topics (8.7%). Many GItools did not possess features considered desirable.
Inclusion of higher quality GItools in guidelines is needed to support user adoption of guidelines. The GItool framework can serve as the basis for evaluating and adapting existing GItools, or developing new GItools. Further research is needed to validate the framework, develop and implement instruments by which developers can apply the framework, and specify which guidelines should be accompanied by GItools.
指南是医疗保健规划、提供和质量改进的基础，但并非总能得到一致实施。很少有指南配有指南实施工具（GItools）。用户要求提供GItools，开发者则要求获得有关如何开发GItools的指导。首先有必要对GItools进行特征描述。本研究的目的是生成一个GItools理想特征的框架。
通过对国际指南界的横断面调查生成代表GItools理想特征的条目。通过在互联网上进行的两轮德尔菲调查，由31名指南开发者、实施者和研究人员对条目进行确认。将所得的GItools框架应用于从国家指南交换中心确定的附有GItools的指南样本。
来自澳大利亚、加拿大、英国、美国、荷兰和其他各国的96名受访者完成了横断面调查。九项条目中的七项被大多数人评为理想条目。来自包括澳大利亚、加拿大、德国、新西兰、秘鲁、沙特阿拉伯、西班牙、英国和美国在内的10个国家的31名专家小组成员参与了两轮德尔菲调查。十项条目在第一轮中达成共识，被视为GItools的理想特征，另有两项在第二轮中达成共识。在149项关于各种临床主题的指南中，共识别出13个用于资源规划、实施和评估的GItools（8.7%）。许多GItools并不具备被认为理想的特征。
指南中需要纳入更高质量的GItools，以支持用户采用指南。GItools框架可作为评估和调整现有GItools或开发新GItools的基础。需要进一步研究以验证该框架，开发并实施开发者可应用该框架的工具，并明确哪些指南应配有GItools。
