The effect of evidence-based, treatment-oriented, clinical practice guidelines on improving patient care outcomes: a systematic review protocol (original) (raw)
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Effects of evidence-based clinical practice guidelines on quality of care: a systematic review
Quality and Safety in Health Care, 2009
The authors concluded that Dutch evidence-based guidelines can be effective in improving the process and structure of care. However, patient health outcomes were studied far less and data were less convincing. The authors' conclusions represented the evidence presented, but presence of non-randomised studies and significant clinical variation between studies made the reliability of the authors' conclusions unclear. Authors' objectives To evaluate the effectiveness of Dutch evidence-based clinical guidelines in improving the quality of care. Searching MEDLINE and EMBASE were searched from 1990 to May 2007. Search terms were reported. Two Dutch scientific journals were searched. Reference lists of retrieved articles were searched. Study selection Eligible studies were randomised controlled trials (RCTs), interrupted time series or before or after studies that concerned evidence-based Dutch guidelines (local or regional protocols and guidelines derived from national guidelines included) that assessed adherence to recommendations related to the process and structure of care and/or effects of guidelines on patient health outcomes. Drug formularies, patient guidelines and European guidelines were excluded. Types of healthcare provider included in the review were general practitioners, medical specialists, and other unspecified healthcare providers. Guidelines concerned preventative care, diagnosis and treatment (or a combination of these). The most common medical conditions addressed by the guidelines were: cardiovascular disease; influenza; type II diabetes; lower back pain; asthma; and chronic obstructive pulmonary disorder. Interventions were implemented using either single or multifaceted method. Most studies included in the review targeted general practitioners, were concerned with national guidelines and used multifaceted interventions (educational meetings, distribution of educational material, audit and feedback). Outcome measures of effects on process/structure of care (such as monitoring patient compliance with medication, prescription of appropriate medications, performance of eye and foot exams in diabetic patients) and patient health outcomes (such as health-related quality of life, improved blood pressure and glycosylated haemoglobin, change in smoking habit) varied between studies. Two reviewers independently selected studies for inclusion in the review. Any disagreements were resolved by discussion and consensus. Assessment of study quality Study quality was assessed using the Cochrane Effective Practice and Organisation of Care Group (EPOC) seven-item criteria for RCTs, controlled before and after studies and interrupted time series. Study quality was assessed by one reviewer and checked by a second reviewer. Data extraction The authors did not state how many reviewers performed data extraction. Methods of synthesis Due to heterogeneity, results were presented in a narrative synthesis. Studies were categorised by the authors as mostly effective (significant effect on more than half the outcome measures), partially effective (significant effect on half or less than half of the outcome measures) and not effective (no significant effect demonstrated).
Evidence-Based Guidelines--An Introduction
Hematology, 2008
Recommendations in the form of clinical practice guidelines are increasingly common. Clinical guidelines are systematically developed statements designed to help administrators, practitioners and patients make decisions about appropriate health care for specific circumstances. In North America, guidelines developed by professional societies, government panels and cooperative groups are frequently used to measure quality, to allocate resources and to determine how health care dollars are spent. For clinicians, guidelines provide a summary of the relevant medical literature and offer assistance in deciding which diagnostic tests to order, which treatments to use for specific conditions, when to discharge patients from the hospital, and many other aspects of clinical practice.
Evidence-based Practice Needs Evidence-based Implementation
Lippincott's Case Management, 2001
Grimshaw and Russell 1 conducted a rigorous systematic review of the impact of tools to guide evidence-based practice. They studied 59 published evaluations of clinical guidelines that met defined criteria for scientific rigor and concluded that all but 4 of the 59 published evaluations detected significant change in the process of care. However, the size of the measured improvement varied substantially. Nine of 11 papers investigated in this review reported that clinical guidelines do improve clinical outcomes. Importantly, Grimshaw and Russell's review identified clinical guidelines that were rigorously implemented, evaluated, and published. 1 Therefore, the positive outcomes identified are only relevant to rigorously implemented, evaluated, and published clinical guidelines and represent a standard of quality in clinical guidelines development that delivers improved care. The rigor of the clinical guidelines in-Clinical pathways have been designed to provide an effective interface between evidence and practice in healthcare. Strong evidence supports the assertion that when clinical pathways are utilized they improve outcomes. However, published evidence measuring the uptake of clinical pathways by health professionals remains sparse.
Evidence-Based Practice: A Guide to Negotiate the Clinical Practice Guideline Maze
Research and Theory for Nursing Practice, 2007
he charge for this issue's column was to write about evidence-based practice and dementia, the issue's theme. This was quite a challenge because, as first author, I did not have expertise in the health problems of dementia and so had no idea about the evidence that may be out there. Being somewhat resourceful, I decided to ask MaryJo Vetter, a geriatric nurse practitioner with whom I have been working at the Visiting Nurse Service of New York, to coauthor this column with me. We first talked about what approach to take in writing as there is an abundance of published information on the topic and this column is certainly not a vehicle for a state-of-the art paper. Several professional activities in which Levin has been engaged over the past year helped focus and narrow our approach. During the past year, Levin consulted with the Hartford Institute for Geriatric Nursing at New York University to provide a framework for revising teaching materials using an evidence-based approach. Prior to that, working with a faculty colleague at Pace University, she devised a teaching strategy to use with family nurse practitioner students to develop their ability to critically appraise clinical practice guidelines (Singleton & Levin, 2006). In both of these endeavors, the AGREE instrument (AGREE Collaboration, 2001) was used. According to Lucas and Fulmer (2003), "Clearly, best practice protocols and guidelines are not valuable for clinical decision making unless they are up-to-date and provide current evidence from research" (p. 2). Lucas and Fulmer also point out that the knowledge base for geriatric nursing is growing rapidly. Therefore, the ability to assess clinical practice guidelines for their validity and incorporation of the best available evidence are crucial. Also important is to define what we mean by clinical practice guidelines. So let us first define relevant terms. Guidelines, protocols, and recommendations are often used interchangeably by health professionals. A recommendation is a suggestion for practice, not necessarily sanctioned by a formal, expert group. A clinical practice guideline (CPG) is an official recommendation or generally prescribed approach to diagnose and manage a broad health condition, such
Instruments to assess Evidence-Based Practice among healthcare professionals: a systematic review
2021
The study makes it possible to select the most appropriate instruments to evaluate the use of Evidence-Based Practice (EBP) among health professionals. The objective of this study was to assess the measurement properties, summarize and describe the instruments that evaluate the use of EBP in health professionals, currently available through the update of the systematic review. The study was conducted and reported according to recommendations of the PRISMA checklist. A systematic search was conducted in the databases: PubMed, Embase, CINAHL and ERIC. In addition, three groups of search terms: EBP terms; evaluation; cross-cultural adaptation and measurement proprieties. They included studies that showed assessment tools of EBP in healthcare workers in general publication of full-text scientific articles, which tested the measurement properties and publication of an article in English. Searches included published studies from 2006 until July 2020. Evaluation of the methodological quali...
Otolaryngology–Head and Neck Surgery, 2006
G uidelines showcase an organization's ability to create documents of high methodological rigor that facilitate evidencebased decisions. An organization's capacity to influence patient health and public policy-and to preserve autonomydepends largely on the scope, quality, and accessibility of its guideline repertoire. Although there are many approaches to developing guidelines, the authoring process tends to be complex, time consuming, and inefficient. Moreover, the resulting guidelines are often poorly suited to influence care or to assess performance or quality, because the recommendations do not always translate into actions or activities that can be readily implemented and measured. The tested, pragmatic, step-by-step approach outlined herein is based upon the following assumptions and underlying principles: • Guideline development must be systematic, transparent, and evidence-based, yet highly efficient. The goal is to produce high-quality guidelines within 12 months. • Guidelines should contain a series of key, boldfaced action statements that can be used to describe desired behavior, measure performance, and assess quality. Each of these key, boldfaced action statements is followed by text that reviews the supporting research and includes an evidence profile summarizing how the policy was created. Guidelines differ from systematic reviews or meta-analyses, which identify and combine studies but typically do not define action or incorporate values. In contrast, a guideline assigns strengths of recommendation to key action statements based on supporting evidence, harms vs benefits, explicitly defined group values, and patient preference. Guidelines differ from evidence reports, which summarize relevant studies in evidence tables and then combine results, when feasible, using meta-analysis. Evidence reports, often produced by the Agency for Healthcare Research and Quality (AHRQ), are intended to aid in developing clinical practice guidelines and medical review criteria. • Guideline development should be multidisciplinary, even if the authors deal with a specific clinical condition or procedure. The guideline will only possess clout and be widely applicable if it is developed with input from specialists, primary care clinicians, and all other groups with a stake in caring for the patient at any point during the course of a disease, condition, or procedure.
Quality & safety in health care, 2010
Despite the increasing number of manuals on how to develop clinical practice guidelines (CPGs) there remain concerns about their quality. The aim of this study was to review the quality of CPGs across a wide range of healthcare topics published since 1980. The authors conducted a literature search in MEDLINE to identify publications assessing the quality of CPGs with the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument. For the included guidelines in each study, the authors gathered data about the year of publication, institution, country, healthcare topic, AGREE score per domain and overall assessment. In total, 42 reviews were selected, including a total of 626 guidelines, published between 1980 and 2007, with a median of 25 CPGs. The mean scores were acceptable for the domain 'Scope and purpose' (64%; 95% CI 61.9 to 66.4) and 'Clarity and presentation' (60%; 95% CI 57.9 to 61.9), moderate for domain 'Rigour of development' (43%; 95% CI 4...
Systematic Review and its Relationship with Evidence-Based Practice in Health
Revista Latino-Americana de Enfermagem, 2010
Systematic reviews (SR) have gained relevance in the world and Latin America because of their credibility in the search, compilation, arranging and analysis of the information obtained from research about health interventions, during a period of time. Consequently, evidence-based practice uses SR as a way to capture the best evidence of clinical effectiveness. This article reviews SR methodology, process, and its usefulness in health professions like nursing and medicine.