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From Evidence to EMS Practice: Building the National Model. Eddy Lang, MD, CFPC (EM), CSPQ SMBD-Jewish General Hospital, McGill University Montreal, Canada . Overview. Research evidence versus consensus/expert based CPGs Avoiding GOBSAT methodology Unique EMS aspects to consider

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from evidence to ems practice building the national model

From Evidence to EMS Practice: Building the National Model

Eddy Lang, MD, CFPC (EM), CSPQ

SMBD-Jewish General Hospital,

McGill University

Montreal, Canada

overview
Overview
  • Research evidence versus consensus/expert based CPGs
  • Avoiding GOBSAT methodology
  • Unique EMS aspects to consider
  • A broader perspective about CPGs
  • Other aspects that can influence this CPG project
clinical practice guidelines
Clinical practice guidelines

Systematically developed statements or recommendations to assist practitioner about appropriate health care for specific clinical circumstances.

Institute of Medicine (1992). Guidelines for clinical practice: from development to use.

the promise of guidelines
The promise of guidelines
  • Evidence Synthesis
  • Reduced variation in care
  • Guidance
  • Improved patient outcomes
  • Improved system efficiency
  • Benchmarks
the pitfalls of guidelines
The pitfalls of guidelines
  • Biased
  • Overwhelming
  • Confusing
  • Directionless
  • Driven only by evidence
  • Not implemented
primary domains of cpg development
Options

Questions

Search

Selection

Appraisal

Strength of evidence

Combining studies

Effect size

Primary Domains of CPG Development

Evidence Mastery

primary domains of cpg development1
Primary Domains of CPG Development

Evidence Mastery

Context

Risk/benefits

Values

Preferences

slide9

Reliable

Clear

Valid

Implementable

Graded Recommendations

Transparent

Credible

Unbiased

what makes a great cpg
What makes a great CPG?
  • What domains are important?
  • What criteria within each domain?
  • Can a rigorously developed appraisal tool inform?
slide11

Appraisal of Guidelines for

Research and Evaluation

agree instrument
AGREE instrument
  • Generic tool designed primarily to help guideline developers
  • Developed by international collaborative group including 16 partners from 12 countries (including Canada, New Zealand, US)
  • Reliability and some aspects of validity assessed
  • Users guide available
  • Translated into most European languages (including French)
agree structure
AGREE STRUCTURE

Six domains – 23 items

1. Scope & purpose (3)

2. Stakeholder involvement (4)

3. Rigour of development (7)

4. Clarity & presentation (4)

5. Applicability (3)

6. Editorial independence (2)

domain 1 scope and purpose
DOMAIN 1.SCOPE AND PURPOSE

1. The overall objective(s) of the guideline is(are) specifically described.

2. The clinical question(s) covered by the guideline is(are) specifically described.

3. The patients to whom the guideline is meant to apply are specifically described.

domain 2 stakeholder involvement
DOMAIN 2.STAKEHOLDER INVOLVEMENT

4. The guideline development group includes individuals from all the relevant professional groups.

5. The patients’ views and preferences have been sought.

6. The target users of the guideline are clearly defined.

7. The guideline has been piloted among target users.

domain 3 rigour of development 1
DOMAIN 3.RIGOUR OF DEVELOPMENT (1)

8. Systematic methods were used to search for evidence.

9. The criteria for selecting the evidence are clearly described.

10. The methods used for formulating the recommendations are clearly described.

11. The health benefits, side effects and risks have been considered in formulating the recommendations.

domain 3 rigour of development 2
DOMAIN 3.RIGOUR OF DEVELOPMENT (2)

12. There is an explicit link between the recommendations and the supporting evidence.

13. The guideline has been externally reviewed by an expert panel prior to publication.

14. A procedure for updating the guideline is provided.

domain 4 clarity and presentation
DOMAIN 4.CLARITY AND PRESENTATION

15. The recommendations are specific and unambiguous.

16. The different options for management of the condition are clearly presented.

17. Key recommendations are easily identifiable.

18. The guideline is supported with tools for application.

domain 5 applicability
DOMAIN 5.APPLICABILITY

19. The potential organisational barriers in applying the guideline have been discussed.

20. The potential costs implications of applying the recommendations have been considered.

21. The guideline presents key review criteria for monitoring and/or audit purposes.

domain 6 editorial independence
DOMAIN 6.EDITORIAL INDEPENDENCE

22. The guideline is editorially independent from the funding body.

23. Conflicts of interest of guideline development members have been recorded.

slide27

Grading of Recommendations Assessment,

Development and Evaluation

closing thoughts
Closing thoughts
  • Exciting times in CPG development
  • Much accumulated wisdom
  • Many challenges to meet
  • Unprecedented opportunity to improve EMS patient care