Establishment of the instrument for evaluating clinical applicability of guidelines (version 2.0)_Chinese Journal of Evidence-Based Medicine

Authors：

LI Siyu ^1,2,3,4,5 , DIAO Sha ^1,2,3,4 , SHI Yuqing ^1,2,3,4,6 , LIU Zheng ^1,2,3,4,5 , ZENG Linan ^1,2,3,4 , YI Qiusha ^1,2,3,4 , LI Hailong ^1,2,3,4 , HUANG Chao ⁷ ,  WANG Qiang ⁷ , ZHANG Lingli ^1,2,3,4,8

1. Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Evidence-based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. NMPA Key Laboratory for Technical Research on Drug Products in vitro and in vivo Correlation, Chengdu 610041, P. R. China;
4. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu 610041, P. R. China;
5. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
6. West China School of Pharmacy, Sichuan University, Chengdu 610041, P. R. China;
7. Medical Management Service Guidance Center, National Health Commission of the People’s Republic of China, Beijing 100044, P. R. China;
8. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WANG Qiang, Email: jason2019@sina.cn

Keywords：

Clinical applicability; Clinical practice guideline; Evaluation instrument; Update

DOI：

10.7507/1672-2531.202207136

Video：

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Objective To update and form an instrument for evaluating clinical applicability of guidelines (version 1.0). Methods We updated the systematic review of global guideline clinical applicability evaluation instruments to form the initial item list and carried out Delphi expert consultation to establish the instrument for evaluating clinical applicability of guidelines (version 2.0). Results The general structure of version 2.0 was consistent with that of version 1.0, which included 12 evaluation items belonging to five domains covering accessibility, readability, acceptability, feasibility, and an overall evaluation. Moreover, some new items were added in version 2.0, such as "The guideline does not provide supporting tools or resources and the operation is poor", "After the guideline implementation, the expected effects of diagnosis and treatment do not be achieved", " Medical staff in your workplace believe that the guideline is not necessary because they have sufficient medical experience, etc.", "Lack of authority of the organizations and personnel that developed the guideline" and "Medical staff in your workplace are reluctant to change the original medical practice". Conclusion This study updated and formed an instrument for evaluating clinical applicability of guidelines (version 2.0), which is able to better assess the applicability of new clinical guidelines and greatly promote more appropriate guidelines into practice.

Citation： LI Siyu, DIAO Sha, SHI Yuqing, LIU Zheng, ZENG Linan, YI Qiusha, LI Hailong, HUANG Chao, WANG Qiang, ZHANG Lingli. Establishment of the instrument for evaluating clinical applicability of guidelines (version 2.0). Chinese Journal of Evidence-Based Medicine, 2023, 23(5): 597-601. doi: 10.7507/1672-2531.202207136 Copy

1.	Institute of Medicine (US) Committee to Advise the Public Health Service on Clinical Practice Guidelines. Clinical practice guidelines: directions for a new program. Washington (DC): National Academies Press (US), 1990.
2.	Barth JH, Misra S, Aakre KM, et al. Why are clinical practice guidelines not followed. Clin Chem Lab Med, 2016, 54(7): 1133-1139.
3.	Francke AL, Smit MC, de Veer AJ, et al. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak, 2008, 8: 38.
4.	Mickan S, Burls A, Glasziou P. Patterns of 'leakage' in the utilisation of clinical guidelines: a systematic review. Postgrad Med J, 2011, 87(1032): 670-679.
5.	王强, 李幼平, 张伯礼, 等. 指南临床适用性评价的问题与需求. 中国循证医学杂志, 2020, 20(3): 249-251.
6.	林茂, 曾力楠, 李佳莲, 等. 全球指南临床适用性评价工具现状的系统评价. 中国循证医学杂志, 2020, 20(4): 437-443.
7.	曾力楠, 易秋莎, 张川, 等. 制订指南临床适用性评价工具. 中国循证医学杂志, 2020, 20(4): 466-475.
8.	李海龙, 张川, 黄超, 等. 指南临床适用性评价工具信效度分析. 中国循证医学杂志, 2020, 20(4): 378-382.
9.	黄超, 李海龙, 张川, 等. 指南临床适用性评价实证研究: 以糖尿病指南临床适用性评价为例. 中国循证医学杂志, 2020, 20(5): 536-542.
10.	张川, 李海龙, 黄超, 等. 指南临床适用性评价实证研究: 以肾移植指南临床适用性评价为例. 中国循证医学杂志, 2020, 20(5): 543-550.
11.	Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines. A framework for improvement. JAMA, 1999, 282(15): 1458-1465.
12.	Cochrane LJ, Olson CA, Murray S, et al. Gaps between knowing and doing: understanding and assessing the barriers to optimal health care. J Contin Educ Health Prof, 2007, 27(2): 94-102.
13.	Veldhuijzen W, Ram PM, van der Weijden T, et al. Characteristics of communication guidelines that facilitate or impede guideline use: a focus group study. BMC Fam Pract, 2007, 8: 31.
14.	Larisch A, Oertel WH, Eggert K. Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson's disease: a national survey of German neurologists in private practice. J Neurol, 2009, 256(10): 1681-1688.
15.	Lugtenberg M, Zegers-van Schaick JM, Westert GP, et al. Why don't physicians adhere to guideline recommendations in practice. An analysis of barriers among Dutch general practitioners. Implement Sci, 2009, 4: 54.
16.	Trudel T, McCune A, Donahue K, et al. Variables influencing adoption of practice-based guidelines in Canadian renal dietetic practice. J Ren Nutr, 2010, 20(4): 235-242.
17.	Gagliardi AR, Brouwers MC, Palda VA, et al. How can we improve guideline use: a conceptual framework of implementability. Implement Sci, 2011, 6: 26.
18.	Flottorp SA, Oxman AD, Krause J, et al. A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci, 2013, 8: 35.
19.	van der Wees PJ, Zagers CA, de Die SE, et al. Developing a questionnaire to identify perceived barriers for implementing the Dutch physical therapy COPD clinical practice guideline. BMC Health Serv Res, 2013, 13: 159.
20.	Kastner M, Bhattacharyya O, Hayden L, et al. Guideline uptake is influenced by six implementability domains for creating and communicating guidelines: a realist review. J Clin Epidemiol, 2015, 68(5): 498-509.
21.	Brolliar SM, Moore M, Thompson HJ, et al. A Qualitative study exploring factors associated with provider adherence to severe pediatric traumatic brain injury guidelines. J Neurotrauma, 2016, 33(16): 1554-1560.
22.	李慧, 谢秀丽, 王洋洋, 等. 中医(中西医结合)临床实践指南制修订方法—实施与评价. 中华中医药杂志, 2016, 31(12): 5119-5123.
23.	Jin Y, Li Z, Han F, et al. Barriers and enablers for the implementation of clinical practice guidelines in China: a mixed-method study. BMJ Open, 2019, 9(9): e026328.

1. Institute of Medicine (US) Committee to Advise the Public Health Service on Clinical Practice Guidelines. Clinical practice guidelines: directions for a new program. Washington (DC): National Academies Press (US), 1990.
2. Barth JH, Misra S, Aakre KM, et al. Why are clinical practice guidelines not followed. Clin Chem Lab Med, 2016, 54(7): 1133-1139.
3. Francke AL, Smit MC, de Veer AJ, et al. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak, 2008, 8: 38.
4. Mickan S, Burls A, Glasziou P. Patterns of 'leakage' in the utilisation of clinical guidelines: a systematic review. Postgrad Med J, 2011, 87(1032): 670-679.
5. 王强, 李幼平, 张伯礼, 等. 指南临床适用性评价的问题与需求. 中国循证医学杂志, 2020, 20(3): 249-251.
6. 林茂, 曾力楠, 李佳莲, 等. 全球指南临床适用性评价工具现状的系统评价. 中国循证医学杂志, 2020, 20(4): 437-443.
7. 曾力楠, 易秋莎, 张川, 等. 制订指南临床适用性评价工具. 中国循证医学杂志, 2020, 20(4): 466-475.
8. 李海龙, 张川, 黄超, 等. 指南临床适用性评价工具信效度分析. 中国循证医学杂志, 2020, 20(4): 378-382.
9. 黄超, 李海龙, 张川, 等. 指南临床适用性评价实证研究: 以糖尿病指南临床适用性评价为例. 中国循证医学杂志, 2020, 20(5): 536-542.
10. 张川, 李海龙, 黄超, 等. 指南临床适用性评价实证研究: 以肾移植指南临床适用性评价为例. 中国循证医学杂志, 2020, 20(5): 543-550.
11. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines. A framework for improvement. JAMA, 1999, 282(15): 1458-1465.
12. Cochrane LJ, Olson CA, Murray S, et al. Gaps between knowing and doing: understanding and assessing the barriers to optimal health care. J Contin Educ Health Prof, 2007, 27(2): 94-102.
13. Veldhuijzen W, Ram PM, van der Weijden T, et al. Characteristics of communication guidelines that facilitate or impede guideline use: a focus group study. BMC Fam Pract, 2007, 8: 31.
14. Larisch A, Oertel WH, Eggert K. Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson's disease: a national survey of German neurologists in private practice. J Neurol, 2009, 256(10): 1681-1688.
15. Lugtenberg M, Zegers-van Schaick JM, Westert GP, et al. Why don't physicians adhere to guideline recommendations in practice. An analysis of barriers among Dutch general practitioners. Implement Sci, 2009, 4: 54.
16. Trudel T, McCune A, Donahue K, et al. Variables influencing adoption of practice-based guidelines in Canadian renal dietetic practice. J Ren Nutr, 2010, 20(4): 235-242.
17. Gagliardi AR, Brouwers MC, Palda VA, et al. How can we improve guideline use: a conceptual framework of implementability. Implement Sci, 2011, 6: 26.
18. Flottorp SA, Oxman AD, Krause J, et al. A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci, 2013, 8: 35.
19. van der Wees PJ, Zagers CA, de Die SE, et al. Developing a questionnaire to identify perceived barriers for implementing the Dutch physical therapy COPD clinical practice guideline. BMC Health Serv Res, 2013, 13: 159.
20. Kastner M, Bhattacharyya O, Hayden L, et al. Guideline uptake is influenced by six implementability domains for creating and communicating guidelines: a realist review. J Clin Epidemiol, 2015, 68(5): 498-509.
21. Brolliar SM, Moore M, Thompson HJ, et al. A Qualitative study exploring factors associated with provider adherence to severe pediatric traumatic brain injury guidelines. J Neurotrauma, 2016, 33(16): 1554-1560.
22. 李慧, 谢秀丽, 王洋洋, 等. 中医(中西医结合)临床实践指南制修订方法—实施与评价. 中华中医药杂志, 2016, 31(12): 5119-5123.
23. Jin Y, Li Z, Han F, et al. Barriers and enablers for the implementation of clinical practice guidelines in China: a mixed-method study. BMJ Open, 2019, 9(9): e026328.

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