Download The process of developing National Guidelines supports

2013-02-13
The National Board of
Health and Welfare
The process of developing
National Guidelines supports
implementation
Arvid Widenlou Nordmark
Department of Knowledge Based Policy and Guidance
National Guidelines
Project Manager for breast, colorectal and prostate cancer
E-mail: [email protected]
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2013-02-13
National Guidelines
• Contribute to the efficient use of health care and social
resources, distributed according to need, and governed by
systematic and transparent priority setting
• Support county and municipality councils planning and
working with local health care and social programs
• Provide support for activities based on science (and at
some occasions on proven experience)
• Focus on areas in need of guidance = Controversial
areas, different practices, and Cost vs. Effiency
Content of Guidelines
• Scientific based reviews on
medicine and health
economics
• Rank order (1-10)
• Interventions that should not
be part of routine health care
– Not to do
– Research & Development
• Relevant quality/performance
indicators
• Expected consequences
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The guideline process
COMMUNICATION & SUPPORT
INDICATORS - GOOD CARE
PREPARING
& DELIMITATION
SCIENTIFIC FOUNDATION
- searching,
reviewing &
grading
PRIORITIZING
- recommendations
COMMUNICATION & SUPPORT
INDICATORS - GOOD CARE
PRELIMINARY
VERSION
- regional
seminars
FINAL
VERSION
National
Assessment
and
Evaluation
UPDATING
National Guidelines for Breast,
Colorectal and Prostate Cancer
An example of updating a guideline
• Project started fall 2010
• Scientific foundation during 2011
• Prioritizing during 2012
• Preliminary version 2013 (6th of March)
• National and regional conferences spring 2013
• Final version 2013/2014
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Preparing & delimination
• Hearing or other activity to define condition and
interventions
• In which areas are the biggest needs of
guidance?
• A new guideline or an update?
• In this project we had national guidelines from
2007 as a starting point
Scientific foundation
• systematic search of literature
• assess and summarise the scientific
evidence/summary of findings
• grading the strength of evidence
– GRADE collaboration for an open and systematic
process
• A large number of experts are involved, about
100 in this project
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Prioritizing
How to form a
priority-setting group
• Involvement of stakeholders by a nomination
process
• Balancing regional and professional interests
• Conflicts of interests
• Training-camp
– Framework, purpose of National Guidelines, earlier
experiences, ground-rules, practice!
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Priority-setting group
Profession
M.D.
M.D.
M.D.
OT (arbetster.)
Nurse
Nurse
M.D.
Counselor
Physiotherapy
M.D.
M.D.
M.D.
Nurse
M.D.
M.D.
M.D.
M.D.
Speciality
Oncology
Radiology
Oncology
Diagnose
Breast
Breast
Prostate
Cont. Nurse
Cont. Nurse
Surgeon
Breast
Colorectal
Colorectal
Oncology
Palliative
Radiology
Cont. Nurse
Urology
Surgeon
Urology
General pract.
Colorectal
Colorectal
Prostate
Prostate
Breast
Prostate
Name
Nils-Olof Bengtsson
Pal Bordas
Lars Franzén
Ulrika Persson
Agneta Eriksson
Anne-May Ryytty
Per Nilsson
Aina Johnsson
Ylva Dahlin
Maria Albertsson
Per-Anders Heedman
Christer Lundstedt
Anna-Carin Börjedal
Rolf Lundgren
Anders Cohen
Eva Johansson
Marcela Ewing
Region
Norra
Norra
Norra
Norra
Stockholm-Gotland
Stockholm-Gotland
Stockholm-Gotland
Stockholm-Gotland
Stockholm-Gotland
Sydöstra
Sydöstra
Södra
Södra
Södra
Uppsala/Örebro
Uppsala/Örebro
Västra
Preliminary version
• The starting point of formalizing the
implementation by involving
– County councils/commissioners (political decision
makers, managers)
– Medical and nursing professions
– Patient organizations
• National and regional conferences
– GAP-analyses
– Process of open consultation
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Final version
•
•
•
•
Consider the result from the open consultation
Adjust recommendations
New recommendations?
Consequences are completed from the regions
GAP-analyses
• Settle an organization for quick update and
adjustment
National Assessment and
Evaluation
• To illuminate differences in cancer care between
different counties and hospitals regarding
organizational factors, processes, results and costs
• To evaluate cancer care in Sweden departing from:
– the intentions of the Health and Medical services Act
– the National guidelines
• To evaluate whether the results are as good as
expected
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Publications and ongoing projects
Published:
• Musculo-skeletal diseases
• Primary prevention (life-style)
• Dental-care
• Cancer (breast, colorectal, prostate
and lung cancer)
• Schizophrenia
• Dementia
• Depression and anxiety
• Diabetes (I and II)
• Stroke
• Cardiac care
• Drug abuse
Ongoing:
• Cancer (update of breast, colorectal
and prostate)
• Drug abuse (update)
• Asthma and COPD (update)
• Cardiac diseases (update)
• Palliative care
BACKUP
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Condition
Health
Symptoms
Dementia
Behavioral / psychological
symptoms
Co-morbidity
y
Intervention
Prevention
Assessment
Follow-up
Nursing and care
science
Palliative
treatment
Daily activities
Medicine
Housing
g
Staff training
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