The Importance of Focused Guidelines Dissemination and Implementation Efforts

Previous blogs in this series have described the process of creating clinical practice guidelines, the costs involved, development methodology, standardization and recommendation grading, and the importance of timing. However, even the most well-written, timely and methodologically sound guideline is essentially useless if it doesn’t reach the hands of the right providers at the right time, and in the right format.

Guideline dissemination and implementation efforts are often overlooked, but their importance cannot be overstated. These efforts can take many shapes and forms. The list below provides a brief overview and categorization of some of the most commonly employed, and tried and true methods at increasing the reach and usability of clinical practice guidelines.

Future articles will dive deeper into some of these. We also invite you to leave a comment or reach out to us on social media to let us know which of the topics in the lists below you would like to see a more in-depth guide on

Increasing the Reach:

  • In Person Events and Symposia
    • This is how guidelines were originally written and distributed. Annual conferences and tradeshows, regional events and other symposia are still a fantastic way to ensure the recommendations are being seen and heard.
  • Guideline Libraries
    • Websites and organizations like Guideline Central are a great resource to help scale guideline dissemination efforts. The consolidation of thousands of guidelines in one place increases the likelihood that providers will “organically” find relevant guidelines, even if they weren’t being sought out.
  • Subscriptions to Society Websites and Emails/Newsletters
    • Subscribing to websites, blogs, and newsletters for guidelines-producing organizations, or websites (like ours) that provide “Guideline Alerts” is a great way to stay up to date.
  • Medical Publications (News, Trade Magazines, etc.)
    • There are dozens of medical publications that cover topics such as the release of new guidelines. Some of these publications are general in nature, and others are specialty-specific. All are a great channel to support the dissemination of guidelines.
  • Social Media
    • Both general and medically-focused social media channels can be a great tool for guidelines dissemination.

Derivative Formats to Support Implementation:

  • Guideline Summaries
    • The average clinical practice guideline is over 50 pages long. With hundreds being published each year, assuming every clinician will read every guideline at length is not a realistic expectation. Guideline summaries are a huge time saver, and will quickly communicate key recommendations to the HCPs who need them most.
  • Pocket Guides
    • Similar to guideline summaries, pocket guides are a great tool for HCPs to quickly access the key takeaways from a guideline when referencing at point of care.
  • Slide Sets
    • One of the simplest derivative tools there is, but extremely important. A well-done slide set makes it easier for the biggest advocates/KOLs to teach others. In many cases you can re-use the assets from your Guideline summary / Pocket Guide to make a quick and effective slide set!
  • Webinars and Podcasts
    • Especially for younger providers, having guideline recommendations represented as webinars, podcasts and videos can be worth the investment. Each person learns differently – for those more visually oriented, or for those who prefer to listen to podcasts while commuting, having multimedia derivatives can be the difference between knowing or not knowing the guideline exists.
  • Calculators, Algorithms and Checklists
    • While these can be more costly than most other derivative tools to create, they do offer immense value at point of care. Not all recommendations, and not even all guidelines lend themselves to this format of derivative, but for those that do, it consistently ranks among the most popular resources.
  • Computable guidelines
    • Over the long-term, creating computable clinical practice guidelines will be the most important derivative tool you can create. Not only does it support implementation at point of need, but it also increases the ability to collect data and guidelines’ usage, and to use that data to create better guidelines in the future. Computable guidelines are extremely costly, so you can look to a 3rd party like Guideline Central to help streamline and scale your computable guideline development and dissemination efforts.

Ease-of-use summaries includes appropriate, well-designed formatting and graphics, especially the widely favored presence of management flow algorithms.

Integrating Into Multiple Workflows:

  • Printed Handouts
    • Pocket guides, pocket cards, flashcards, brochures, slim jims, wall charts, posters and more, can all become great implementation tools. While focus on digital continues to grow, studies have shown that the majority of HCPs still use printed materials for clinical decision support at point of care. Don’t ignore print!
  • Digital Toolkits
    • Websites, microsites and similar make it easy for providers to quickly look up information online. These types of tools are an absolute must for any guideline dissemination/implementation efforts.
  • iOS and Android Mobile Applications
    • Internet may not always be available, so having a mobile application for iOS and Android that can display guideline recommendations in the palm of a hand will pay dividends. These can be costly to create, and even more costly to maintain, but apps like ours here at Guideline Central help scale this dissemination tactic. And for providers, it makes it easy, since they don’t need 50+ apps just to get access to the various guidelines that might be needed at any given time.
  • EHR Applications
    • The future of guideline dissemination and implementation resides within the EHR/EMR systems. As standards are developed and enforced, and interoperability becomes more of a reality, the EHR is placed at the forefront. There is no one-size-fits-all approach, however a good starting point is to ensure the guidelines are represented as structured, or at least semi-structured data, along with accompanying meta data. Here at Guideline Central we have developed a tool that enables organizations, both developers, and hospitals implementing pathways, to do just this.

Involving Multiple Audiences and Stakeholders:

  • Patient Guides
    • Even if healthcare providers know every guideline, they only represent 50% of the equation. Not only is patient adherence key, but from a shared decision-making perspective and more, it’s imperative for patients and providers to be on the same page throughout the care process, and translating clinical guidelines into patient guidelines is a fantastic way to do just this. Guideline Central is the premier organization in the world for developing patient and provider guideline implementation tools that are meant to go hand in hand.
  • Payers, Coding, Billing and Compliance Tools
    • Guidelines are among the most influential decision points for payers when it comes to things like prior authorization and reimbursement. They are also one of the stakeholders most interested in seeing guidelines dissemination and implemented, and doing so not only standardizes care and improves outcomes, but it decreases costs as well. Creating outreach and implementation tools geared towards payers, prior authorization, appeals/denials and more can be a worthwhile investment. Additionally, tools like Guidelines+Codes, which combine guideline recommendations with relevant CPT and ICD10 codes, can help from a clinical documentation, coding and compliance standpoint.
  • Variations for Generalists vs. Specialists
    • Most guidelines written by specialty societies are, by nature, written for the specialists that make up the majority of that organization’s members. This is one reason we often see multiple guidelines on the same topic that don’t always agree across the board. As part of dissemination and implementation efforts, it’s important to consider all users/stakeholders of a given guideline, and to create implementation derivative tools that apply to each group. For example, creating separate guideline resources for a Total Knee Arthroplasty Guideline – one for Physical Therapists and one for Orthopaedic Surgeons. Groups like the American Physical Therapy Association (APTA) are one of the leaders in this arena.

Geographic, Demographic and Cultural Adaptations:

  • Language Translations
    • To ensure a guideline is going to be used by the widest number of individuals possible, the guideline must also be available in multiple languages. Even here within the US, translating recommendations in Spanish at a minimum is strongly recommended. If dissemination and implementation goals are worldwide, there are another dozen languages that should be considered. While translations can be costly, there are models (described in funding/support section below) that can help offset some of these costs.
  • Cultural Translations
    • In addition to translating into different languages, translating guideline recommendations on a demographic or culturally level can increase the likelihood of adherence. This can come in many ways. For example, some organizations write specific recommendations for people of different races. Other guidelines address cultural translations by adjusting the stock imagery depending on the location the resource is being distributed in to make it more culturally relevant. Over the years we expect to see cultural translations to become more common as part of dissemination efforts.
  • Resource Stratified Guidelines
    • Not every guideline can be implemented in every setting. For this reason, an increasingly important trend is the publication of resource-stratified guidelines. Our friends at the American Society of Clinical Oncology (ASCO) do a fantastic job with creating these resource-stratified guidelines – these include recommendations for each setting/applicable resource level.

Funding and Support from 3rd Parties:

  • Partnerships with Specialty Organizations
    • Here at Guideline Central we provide guideline developers with dissemination and implementation support, while also providing a means of non-dues revenue to help fund various other types of educational tools. It’s a win-win, and also provides HCPs with more options when it comes to consuming guidelines.
  • Industry via Sales Reps and MSLs
    • While industry should have nothing to do with the development of guidelines, they can and should play a role in dissemination. Partnering with industry, who in turn may disseminate full text reprints, Guidelines Pocket Guides, summaries and more via sales reps and MSLs, is an absolute win-win.
  • CME Programs
    • One of the great benefits of CME’s role in guideline implementation is its ability to quantify the results of the efforts. In addition to providing a measurable outcome, it also incentives providers by offering continuing education credits. Even non-accredited learning activities can be valuable by offering a level of “gamification” to implementation efforts.
  • Grants
    • Grants can be offered by local and national governments, industry charitable organizations and more. There are often dozens of grants at any given time that, if solicited, could help fund wider and more resource-filled guideline dissemination and implementation programs.

Guideline Central partners with over 47 medical associations to develop and disseminate treatment guidelines that provides clinicians the clinical support at point-of-care.

Bonus Idea:

  • Certifications and Performance Awards
    • While these can be resource-intensive to create, the results are impossible to deny. Programs like the American Heart Association’s “Get with the Guidelines” provide a perfect balance of education, tools and incentive for institutions to do just that…Get with the Guidelines. Here at Guideline Central, we can help professional societies, hospitals and other institutions create and implement similar guidelines-based implementation programs, certifications and performance awards.

   

If you are a guidelines-producing specialty society who wants to ensure your guidelines are seen/used more often, or if you are a provider and you or your organization is interested in learning more about how you can stay up to date on current or upcoming guidelines, we are here for you!  Drop us a line at GuidelineCentral.com/contact or by emailing us at “info at guideline central dot com”

Ricker Polsdorfer, MD

Lead Medical Editor


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