05/01/20231

CPG Development (de novo)

vs. Adaptation

Dr. Yasser Sami AmerMBBCh, MS Ped, MS HCI, CPHQ, FISQua

CPG Methodologist, CPG Steering Committee, CPG Unit, Quality Management Department, King Saud University Medical City

CPG Adaptation Workshop, INA Santé, Tunisia, 24-26 May 2016

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What makes a trustworthy CPG?

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Standards for trustworthy CPGsIOM 2011 G-I-N 2012

1- Establishing Transparency 1- Decision making process. 2- Methods2- Management of COI 3- COI3- (GDG) composition 4- GDG composition 4- (CPG – SR) intersection 5- Evidence reviews5- Assign/ link to (LoE) & (GoR) 6- Rating of E & Rs6- Articulation of (Rs) 7- CPG Rs (formulation/ wording) 7- External Review 8- Peer review & stakeholder consultation8- Updating 9- Expiration & updating

10- Scope of CPG11- Financial support/ sponsoring organization

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CPG development (de novo)

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CPG development methodologies

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What is CPG adaptation?“Guideline adaptation is the systematic approach

to the endorsement and/or modification of a guideline(s) produced in one cultural and organizational setting for application in a different context. Where high quality guidelines are already available, adaptation may be used as an alternative to de novo guideline development to customize the existing guideline to the needs of local users.”

The ADAPTE Collaboration (2006-2010)

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Why CPG Adaptation?• Proper development and updating of high-quality CPGs

require substantial time, expertise and resources. • Need of HCOs to standardize health policies and

practices to promote optimal EBHC.• Pressure on HCOs to produce CPGs rapidly, to ensure

that medical practice is consistent with current, emerging medical knowledge. This work is often done with limited resources.

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The ADAPTE postulates that . . . .. . . . .existing high quality CPGs as a resource may be an alternative to de novo development to reduce duplication of effort, enhance efficiency, and promote local uptake of quality CPG recommendations.

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The ADAPTE. . . • The ADAPTE Collaboration was born of two independent

groups focusing on guideline adaptation: the ADAPTE group and the Practice Guideline Evaluation and Adaptation Cycle (PGEAC).

• In 2010, following the development of the ADAPTE Manual and Resource Toolkit & its evaluation, the group asked the G-I-N to ensure the continuity of the work in the area & to make these resources available to the international community through the G-I-N Adaptation Working Group was established.

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Main differences Develop vs. ADAPTE ADAPTE DEVELOP (de novo)Adaptation Development (GDG) Working groupsCheck whether adaptation is feasible then TEAM formation

Team formation Sequence of steps (starting)

PIPOH PICO(T) Health/ Clinical questions

CPGsOrBoth (if mixed methods)

Primary/ secondary studiesEvidence syntheses/ summaries

Evidence Base

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Summary of the ADAPTE

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3 Phases, 9 Modules, 23 Steps

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ADAPTE & AGREE II•Both are validated CPG appraisal tools.

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G-I-N Adaptation Working Group

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Najoua Mlika-Cabanne, MD, PhD• Najoua was born in Tunisia and graduated from the

Sousse Medical Faculty in 1982.• Deputy head of the GPGs Department at the HAS (French

National Authority for Health): in charge of various aspects of CPGs’ development for over 10 years.

• Member of the G-I-N Executive Committee; Board of Trustees 2003-2010; Honorary Patron of the G-I-N 2010, Co-chair of the International Working Group on Evidence Tables, & Co-editor the G-I-N newsletter (enGINe).

• Active member/ contributor in ISQua, ADAPTE, G-I-N. • Died on 7th November 2011.• http://www.g-i-n.net/about-g-i-n/trustees-bio/previous-trustees/najoua-mlika-cabanne/?searchterm=najoua%20mlika

Dr. Yasser Sami Amer

QMD, CPGC, KSUMC3 .yasser amer@yahoo com