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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
  Evidence format Narrative, tabulated or both
  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
  Evidence graded A system is used to categorize quality of evidence supporting each recommendation
  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)
  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)
  User needs/values Identification of stakeholder needs, perspectives, interests or values
  Technical Equipment or technology needed, or the way services should be organized to deliver recommendations
  Regulatory Industrial standards for equipment or technology, or policy regarding their use
  Human resources Type and number of health professionals needed to deliver recommended services
  Professional Education, training or competencies needed by clinicians/staff to deliver recommendations
  Impact Anticipated changes in workflow or processes during/after adoption of recommendations
  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
  Tools Instructions, tools or templates to tailor guideline/recommendations for local context; Point-of-care templates/forms (clinical assessment, standard orders)
  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