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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

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Transparency matters: Kaiser Permanente's National Guideline Program methodological processes.

Carrie Davino-Ramaya¹, L Kendall Krause, Craig W Robbins

¹Quality Management and Systems Department, Northwest Permanente, Portland, OR, USA. carrie.m.davino@kp.org

The Permanente Journal

|April 25, 2012

Summary

This study outlines a rigorous process for developing clinical practice guidelines, ensuring high-quality patient care by synthesizing evidence. It details methods for assessing existing guidelines and creating new ones to reduce variability in care.

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Area of Science:

Health Services Research
Evidence-Based Medicine
Clinical Practice Guideline Development

Background:

Variability in the quality and rigor of evidence summaries and clinical practice guidelines presents a challenge for clinicians.
Ensuring high-quality patient care relies on a systematic process of evidence collection, appraisal, and synthesis for guideline development.

Purpose of the Study:

To describe the methodology used by Kaiser Permanente's National Guideline Program for developing evidence-based clinical practice guidelines.
To ensure the rigor and efficiency of guideline development while addressing variability in care.

Main Methods:

A multidisciplinary stakeholder group develops national guidelines.
Utilizes frameworks like ADAPTE, Appraisal of Guidelines Research and Evaluation, Assessment of Multiple Systematic Reviews (AMSTAR), and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess existing guidelines and systematic reviews.
If no suitable external guidelines are found, systematic searches for high-quality systematic reviews, meta-analyses, and original studies are conducted.
The "body of evidence" is critically appraised using GRADE methodology, considering effects, evidence quality, values, and cost.

Main Results:

National guidelines are disseminated to all eight Kaiser Permanente Regions through an internal Web-based resource.
The process allows for the adoption of existing evidence-based guidelines and systematic reviews.
The GRADE methodology is used to assess the quality of evidence and assign strength to recommendations.

Conclusions:

The described process ensures the development of high-quality, evidence-based clinical practice guidelines.
This systematic approach aims to reduce unwanted variability in patient care.
The integration of appraisal tools and methodologies enhances both the rigor and efficiency of guideline creation.