|
Implementation planning—instructions for when and how to plan and prepare for implementation
|
|
Implementation should be considered at the beginning, and throughout the guideline development process
|
[26-29]
|
|
Form an implementation team from the start that includes stakeholders (patient groups, end users, champions, relevant organizations and agencies, policy-makers) and one or more knowledge translation experts
|
[26-28,30-33]
|
|
Identify and assemble resources for implementation
|
[27,34]
|
|
Audit current practice as a baseline needs assessment
|
[32]
|
|
Consider or assess barriers of guideline implementation and use (patient, professional, organizational, system, economic, political, social/cultural), and stakeholder needs and preferences through literature review, observation, focus groups, interviews or survey
|
[27,30-39]
|
|
Consider dissemination and/or implementation on a recommendation-by-recommendation basis rather than for entire guideline
|
[33]
|
|
Determine the dissemination and implementation strategies that are effective and best suited to address identified needs and barriers
|
[27,30-36,40]
|
|
Determine what implementation tools will be developed based on: guideline scope; guideline recommendations; identified knowledge gaps or baseline audit; interviews or focus groups with guideline users
|
[30,35,40,41]
|
|
Develop an implementation plan describing dissemination and implementation strategies and tools, roles and responsibilities, milestones, time frames, and implementation measures
|
[26-28,32,38,42]
|
|
Consider pilot testing the implementation strategy on a small scale and adjust as needed after the pilot test and on an ongoing basis
|
[32,34,38]
|
|
Continue to engage stakeholders with outreach and education throughout the guideline development process
|
[27,30-33,40]
|
|
Ensure guideline recommendations are implementable and can be integrated in computer decision support systems
|
[35,41]
|
|
Implementation tools—instructions for developing guideline content, versions, or tools that support implementation
|
|
Research potential designs for type(s) of tools selected
|
[30]
|
|
Identify resources that will be needed
|
[30]
|
|
Present draft tool to guideline development group
|
[30]
|
|
Refine the tool with feedback, and several iterations may be needed
|
[30]
|
|
Test tool usability with clinician or patient interviews or focus groups
|
[30]
|
|
Feedback is used to refine the tool
|
[30]
|
|
Final version is reviewed by the guideline development group
|
[30]
|
|
Implementation tools are published at the same time as the guideline
|
[26]
|
|
Potential implementation tools include:
| |
|
Versions in different languages
|
[27,28,43]
|
|
Versions in different formats (mobile devices, pocket guide, wall poster)
|
[26,29-31,44-47]
|
|
Summary versions (short version, recommendations only, evidence only)
|
[26,28,29,32,35,37,38,42-44,46-51]
|
|
Patient or plain language version
|
[26,27,35,43,46,48,49]
|
|
Point-of-care tools (algorithms, checklists, decision aids)
|
[27,28,35,36,38,48-50,52]
|
|
Electronic medical record/computer decision support system integration
|
[30]
|
|
Implementation plan (recommended strategies, barriers specific to the guideline and its recommendations, instructions)
|
[28,36,43,48,53,54]
|
|
Teaching aids (slide set, case examples, meeting agenda)
|
[27,42,47,49,52,53]
|
|
Patient and caregiver resources
|
[28,32,35,36,45,48,50,52]
|
|
Resource planning guide (human, infrastructure, technological capacity needed to implement and apply the recommendations)
|
[36,48]
|
|
Costing tools (spreadsheet, report templates)
|
[26,53]
|
|
Evaluation plan (instructions, measures, data collection instruments)
|
[26-28,32,35,36,39,45,48,50,53]
|
|
Dissemination and implementation—strategies for distributing, sharing, promoting and applying guideline recommendations
|
|
Dissemination options include:
| |
|
Web site (guideline, implementation tools, accredited CPD modules)
|
[26,27,29,32,35,38,43-49,51,55-58]
|
|
Journal publications (which can link to online material)
|
[26,27,29,30,35,37,42-49,51,55-57,59,60]
|
|
Press release
|
[31,35,47,49]
|
|
Mass media campaign
|
[27,30,32-34,41]
|
|
Email distribution
|
[35,44,49]
|
|
Podcast or webinar
|
[35,45]
|
|
Register with AHRQ Guideline Clearinghouse and G-I-N Library
|
[35]
|
|
Partnerships (national organizations, networks)
|
[26,31,45]
|
|
Endorsement by specialty society
|
[31,45]
|
|
Marketing strategies
|
[31]
|
|
Traditional arts
|
[31]
|
|
Implementation options include:
| |
|
Printed educational material
|
[31-34,36,40,41]
|
|
Educational meetings (conferences, workshops, CPD)
|
[26,30-36,39-42,44,46,60]
|
|
Educational outreach/Academic detailing
|
[32-34,36,40,41,60]
|
|
Local opinion leaders
|
[32-34,36,40,41,60]
|
|
Audit and feedback
|
[32-34,36,40-42,60]
|
|
Reminders
|
[32,33,36,39-41,60]
|
|
Multi-faceted interventions
|
[32,36]
|
|
Patient-mediated interventions (educational material, decision support tools, mass media campaign, reminders)
|
[32-43,40]
|
|
Organizational interventions (revision of professional roles or teams, leadership engagement)
|
[33,34,40]
|
|
Financial incentives or penalties
|
[32,33,41]
|
|
Computer decision support systems
|
[33,41]
|
|
Regulatory interventions/accreditation
|
[33,41,42]
|
