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Kaiser Permanente National Guideline Program (NGP): Implications of IOM CPG Standards. Craig Robbins, MD, MPH KP Colorado-Family Physician Medical Director-KP National Guideline Program. Kaiser Permanente: Largest Non-Profit Health Care Program in the United States. Founded in 1945

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kaiser permanente national guideline program ngp implications of iom cpg standards

Kaiser PermanenteNational Guideline Program (NGP):Implications ofIOM CPG Standards

Craig Robbins, MD, MPH

KP Colorado-Family Physician

Medical Director-KP National Guideline Program

kaiser permanente largest non profit health care program in the united states
Kaiser Permanente: Largest Non-Profit Health Care Program in the United States

Founded in 1945

8 regions in 9 states and District of Columbia

8.6 million members (as of 12/09)

15,129 physicians (as of 12/09)

164,098 employees (as of 12/09)

KP Care Management Institute (CMI)

KP National Guideline Program (NGP)

Permanente

Medical

Groups

Kaiser

Permanente

Kaiser

Foundation

Hospitals

Kaiser

Foundation

Health Plan

kaiser permanente evidence network
Kaiser PermanenteEvidence Network
  • 15 KP National Evidence-Based Guidelines
    • Supported by full systematic reviews
  • 3.5 staff FTEs dedicated to KP NGP work
    • 1 Principal Consultant, 2 Evidence Analysts, 2 Project Managers
  • 1.5 physician FTEs dedicated to KP NGP work
    • 7 Physician EBM Methodologists
  • External Vendor: Doctor Evidence
    • Search & Data Extraction
    • Technology platform
      • Data repository, analysis & documentation
kp national guideline program portfolio
Asthma-Adult

Asthma-Child/Adolescent

ADHD

Breast Cancer Screening

Cervical Cancer Screening

Colorectal Cancer Screening

CAD

Depression

Diabetes

Dyslipidemia (Integrated CVD Risk Reduction)

Heart Failure

HIV/STI Screening & Prevention

Hypertension

Osteoporosis

Prostate Cancer Screening

KP National GuidelineProgram Portfolio
iom clinical practice guideline standards congruent areas for kp
IOM Clinical Practice Guideline Standards: Congruent Areas for KP
  • Establishing transparency
  • Management of conflict of interest
  • GDG Composition:
    • Multidisciplinary & balanced
  • CPG-SR intersection
  • Evidence foundations & strength of recommendations
  • Articulation of recommendations
  • Updating
iom clinical practice guideline standards problem areas for kp
IOM Clinical Practice Guideline Standards: Problem Areas for KP

GDG composition

Patient & public involvement

Strategies to increase effective participation of patient and consumer representatives

External review

No review outside KP

No posting for public comment

kaiser permanente national guideline program process methodology
Kaiser Permanente National Guideline Program: Process & Methodology

New

Clinical

Issue

ScheduledUpdate

  • Key to Abbreviations:
  • CQ Clinical Question
  • SR Systematic Review
  • GDT Guideline Development Team
  • GQ Guideline Quality Committee
  • NGD KP National Guideline Directors

Clinical

Questions

(CQ)

  • Overview

Existing

Guideline?

No

Yes

CQ

Match?

Existing

SR by CQ?

Evidence

Search

Abstract

Article

Review

Inclusion/

Exclusion

Data

Extraction

Critical

Appraisal

No

No

Yes

Yes

Assess

Guideline

Assess

SR

Qualitative/

Quantitative

Synthesis

Assess

Evidence

Quality

Evidence

Summary

Rationale

Recommendations

Acceptable?

Acceptable?

No

No

Assess

Implementability of

Recommendations

GDT Approval

Internal Review

GQ

NGD

Approval

Yes

Yes

New Relevant

Studies?

National

Guideline

Yes

No

Implementation

kaiser permanente national guideline program process methodology1
Kaiser Permanente National Guideline Program: Process & Methodology

New

Clinical

Issue

ScheduledUpdate

Clinical

Questions

(CQ)

  • Acceptable External Guideline
  • ADAPTE/AGREE

Existing

Guideline?

Yes

CQ

Match?

Yes

Assess

Guideline

Acceptable?

GDT Approval

Internal Review

GQ

NGD

Approval

Yes

National

Guideline

Implementation

kaiser permanente national guideline program process methodology2
Kaiser Permanente National Guideline Program: Process & Methodology

New

Clinical

Issue

ScheduledUpdate

Clinical

Questions

(CQ)

  • No Acceptable External Guideline
  • Acceptable External Systematic Review
    • No New Relevant Studies
  • Modified AMSTAR
  • GRADE

Existing

Guideline?

No

Yes

CQ

Match?

Existing

SR by CQ?

No

Yes

Yes

Assess

Guideline

Assess

SR

Evidence

Summary

Rationale

Recommendations

Acceptable?

Acceptable?

No

Assess

Implementability of

Recommendations

GDT Approval

Internal Review

GQ

NGD

Approval

Yes

New Relevant

Studies?

National

Guideline

No

Implementation

kaiser permanente national guideline program process methodology3
Kaiser Permanente National Guideline Program: Process & Methodology

New

Clinical

Issue

ScheduledUpdate

Clinical

Questions

(CQ)

  • No Acceptable External Guideline
  • No Acceptable External Systematic Review
  • Internal Systematic Review
  • GRADE

Existing

Guideline?

No

Yes

CQ

Match?

Existing

SR by CQ?

Evidence

Search

Abstract

Article

Review

Inclusion/

Exclusion

Data

Extraction

Critical

Appraisal

No

No

Yes

Yes

Assess

Guideline

Assess

SR

Qualitative/

Quantitative

Synthesis

Assess

Evidence

Quality

Evidence

Summary

Rationale

Recommendations

Acceptable?

Acceptable?

No

No

Assess

Implementability of

Recommendations

GDT Approval

Internal Review

GQ

NGD

Approval

National

Guideline

Implementation

kaiser permanente national guideline program process methodology4
Kaiser Permanente National Guideline Program: Process & Methodology
  • Guideline Implementation

National

Guideline

Regions

(EHR, CDS,

Operations)

Patient Education

Tools

(KP.ORG,

National Patient

Instructions

Clinician &

Staff Education

Tools

(Clinical Library)

Disease

Management

Accreditation

(NCQA)

  • Key to Abbreviations:
  • EHR Electronic Health Record
  • CDS Clinical Decision Support
  • KP.ORG KP publicly-accessible Internet site
  • NCQA National Committee for Quality Assurance
cpg challenges
CPG Challenges
  • Infinite needs/finite resources
  • Balancing rigor with efficiency
  • Updating requirements
    • Every 2 years?
    • Dynamic updating, based on evidence & impact?
  • Patient/public involvement
  • Rigor of external SRs/CPGs
  • Implementation of CPGs at the point of care
cpg opportunities
CPG Opportunities
  • Improved SR & CPG rigor & transparency
  • Common evidence-grading & recommendation strength framework
  • SR & CPG developer collaboration
    • Prioritize & coordinate topics
    • Avoid duplication
    • Target funding
  • Collaboration with performance metric developers
kp national guideline program
KP National Guideline Program
  • Questions?
  • My contact information:

Craig Robbins, MD, MPH

Email: craig.w.robbins@kp.org

Phone: 303-614-1103

Address:

10065 E Harvard Ave, Suite 250

Denver, CO 80231