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Table 1 Guideline implementability framework

From: Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice

Domain Definition Element Examples
Adaptability The guideline is available in a variety of versions for different users or purposes Sources Internet, peer reviewed journal
Versions Full text, summary, print, digital
Users Tailored for patients or caregivers
Useability Content is organized to enhancethe ease with which the guideline can be used Navigation Table of contents
Evidence Narrative, tabulated or both
Recommendations Narrative, graphic (algorithms) or both; Recommendation summary (single list in full or summary version rather than dispersed)
Validity Evidence is summarized and presented such that its quantity and quality are apparent 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
Applicability Information is provided to help interpret and apply guidelines for individual patients Clinical considerations Information such as 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
Communicability Resources for providers or patients to inform, educate, support and involve patients Inform, educate, support Informational, educational or supportive resources for patients/caregivers, or contact information (phone, fax, email or URL) for such resources
Decision making Questions or tools for clinicians to facilitate discussion with patients, or decision aids to support patient involvement
Relevance The focus or purpose of the guideline is explicitly stated Objective Explicitly stated purpose of guideline (clinical, education, policy, quality improvement)
Stakeholders Specify who would deliver (individuals, teams, departments, institutions, managers, policy makers, internal/external agents) and receive the services (specify type of patients)
Needs Identification of stakeholder needs, perspectives, interests or values
Accommodation Anticipated changes, resources and competencies required to adapt and accommodate guideline utilization are identified Technical Equipment or technology needed, or the way services should be organized
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
Workflow Anticipated changes in workflow or processes during/after adoption of recommendations
Costs Direct or productivity costs incurred by acquiring resources or training to accommodate guidelines, or as a result of service reductions during transition from old to new processes
Implementation Processes for planning and applying local strategies to promote guideline utilization are described Identify barriers Individual, organizational, or system barriers that could challenge adoption, or instructions for local needs assessment of guideline users
Tailor guideline Instructions, tools or templates to tailor guideline/recommendations for local context
Integrated tools Point-of-care templates/forms (clinical assessment, standard orders) to integrate guidelines within care delivery processes
Promote utilization Possible mechanisms by which to promote guideline utilization
Evaluation Processes for evaluating guideline implementation and utilization are described Implementation Methods for evaluating the implementation process
Utilization Audit tools or performance measures/quality indicators to assess the organization, delivery and outcomes of guideline recommended care