Table 4 Final framework of guideline implementability
From: How can we improve guideline use? A conceptual framework of implementability
Domain | Element | Examples |
|---|---|---|
Usability | Navigation | Table of contents |
| Â | Evidence format | Narrative, tabulated or both |
| Â | Recommendation format | Narrative, graphic (algorithms) or both; Recommendation summary (single list in full or summary version) |
Adaptability | Alternate versions | Summary (print, electronic for PDA); Patient (tailored for patients/caregivers); Published (journal) |
Validity | Number of references | Total number of distinct references to evidence upon which recommendations are based |
| Â | Evidence graded | A system is used to categorize quality of evidence supporting each recommendation |
| Â | Number of recommendations | Total number of distinct recommendations (sub-recommendations considered same) |
Applicability | Individualization | Clinical information (indications, criteria, risk factors, drug dosing) that facilitates application of the recommendations explicitly highlighted as tips or practical issues using sub-titles or text boxes, or summarized in tables and referred to in recommendations or narrative contextualizing recommendations |
Communicability | Patient education or involvement | Informational or educational resources for patients/caregivers, questions for clinicians to facilitate discussion, or contact information (phone, fax, email or URL) to acquire informational or educational resources |
Accommodation | Objective | Explicitly stated purpose of guideline (clinical decision making, education, policy, quality improvement) |
| Â | Users | Who would deliver/enable delivery of recommendations (individuals, teams, departments, institutions, managers, policy makers, internal/external agents), who would receive the services (patients/caregivers) |
| Â | User needs/values | Identification of stakeholder needs, perspectives, interests or values |
| Â | Technical | Equipment or technology needed, or the way services should be organized to deliver recommendations |
| Â | Regulatory | Industrial standards for equipment or technology, or policy regarding their use |
| Â | Human resources | Type and number of health professionals needed to deliver recommended services |
| Â | Professional | Education, training or competencies needed by clinicians/staff to deliver recommendations |
| Â | Impact | Anticipated changes in workflow or processes during/after adoption of recommendations |
| Â | Costs | Direct or productivity costs incurred as a result of acquiring resources or training needed to accommodate recommendations, or as a result of service reductions during transition from old to new processes |
Implementation | Barriers/facilitators | Individual, organizational, or system barriers that are associated with adoption |
| Â | Tools | Instructions, tools or templates to tailor guideline/recommendations for local context; Point-of-care templates/forms (clinical assessment, standard orders) |
| Â | Strategies | Possible mechanisms by which to implement guideline/recommendations |
Evaluation | Monitoring | Suggestions for evaluating compliance with organization, delivery and outcomes of recommendations, including program evaluation, audit tools, and performance measures/quality indicators |