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báo cáo khoa học: "How can we improve guideline use? A conceptual framework of implementability"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: How can we improve guideline use? A conceptual framework of implementability | Gagliardi et al. Implementation Science 2011 6 26 http www.implementationscience.eom content 6 1 26 IMPLEMENTATION SCIENCE Implementation Science RESEARCH Open Access How can we improve guideline use A conceptual framework of implementability Anna R Gagliardi1 Melissa C Brouwers2 Valerie A Palda3 Louise Lemieux-Charles4 and Jeremy M Grimshaw5 Abstract Background Guidelines continue to be underutilized and a variety of strategies to improve their use have been suboptimal. Modifying guideline features represents an alternative but untested way to promote their use. The purpose of this study was to identify and define features that facilitate guideline use and examine whether and how they are included in current guidelines. Methods A guideline implementability framework was developed by reviewing the implementation science literature. We then examined whether guidelines included these or additional implementability elements. Data were extracted from publicly available high quality guidelines reflecting primary and institutional care reviewed independently by two individuals who through discussion resolved conflicts then by the research team. Results The final implementability framework included 22 elements organized in the domains of adaptability usability validity applicability communicability accommodation implementation and evaluation. Data were extracted from 20 guidelines on the management of diabetes hypertension leg ulcer and heart failure. Most contained a large volume of graded narrative evidence and tables featuring complementary clinical information. Few contained additional features that could improve guideline use. These included alternate versions for different users and purposes summaries of evidence and recommendations information to facilitate interaction with and involvement of patients details of resource implications and instructions on how to locally promote and monitor guideline use. There were no consistent trends by guideline topic. Conclusions