Time Tested Guideline Development and

Implementation:

The Institute for Clinical Systems Improvement (ICSI)

Collaborative Process

© 2007 Institute for Clinical Systems Improvement

Cally Vinz, RN - Director Evidence Based Health Care, ICSI

AHRQ Annual Conference, September 2007

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Who is ICSI?

Established in 1993

A collaborative of 61 member organizations that include medical groups, hospitals and integrated systems

Sponsored by six non-profit

health plans

Mission

Champion the cause of Champion the cause of health health

care qualitycare quality and to and to

accelerate improvementaccelerate improvement in the in the

value value of the health care we of the health care we

deliver. deliver.

We aim to make health care:

Patient-centered and Value-driven

Clinical Patient &

Family GuidelinesGuidelines

• Evidence-based statements of how to prevent, detect, or treat a specific health condition taking into account the preferences of the patient and his or her family.

• The same clinical guidelines developed for health care providers, supplemented by definitions and descriptions of medical terms that are often unfamiliar to people who are not health care professionals.

Order SetsProtocols

• Standardized instructions to manage a disease, condition or procedure

• Presented as a set of orders to be individually selected and signed by an authorized prescriber

• Step-by-step statement of a routine procedure

• To assure intended effect is reliably achieved

Process

• Multidisciplinary & multi-organizational workgroup

• Systematic process for reviewing evidence, regulatory requirements and existing practices

• Development of algorithm and

annotations (citing graded evidence)

— Consensus process to support standardization

Process (cont.)

• Develop implementation and measurement recommendations

• Review and feedback by member organizations

• Respond to comments, revise & release for use

• Updated every 12-36 months

Guideline Sections

• Algorithm & Annotations

• Supporting Evidence

• Implementation

Recommendations

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Where we started:

• “Sure bet” guidelines

• Clinical issues with enough evidence

• Creating many guidelines per year

• Expecting all guidelines to be

implemented

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What we learned:

“Guidelines do not implement themselves” (Field and Mohr, 1992)

• Implementation support - Quality improvement education- Collaborative implementation

• Implementation recommendations

• Measurement

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Where we are now:

• Topics with less definitive evidence

• Implementation recommendations

growing

• More stakeholders involved (patients, employers, plans, DHS,etc)

Collaborative Implementation Strategies

Successful Collaborative Implementation Requires:

• Systems approach• Change management strategies & culture work

• Improvement support

• Transparent measures

Make it easy to do the right thing!

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Topics we are now addressing:

Palliative Care

Primary Prevention of Chronic

Disease

Reliability Centered Surgical

Care (protocols)

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Where we are going:

Redesigning guidelines

– Decision support recommendations

– Making recommendations of what to do

and NOT to do

– Incorporate value recommendations (cost & effectiveness)

– Considerations for EMR’s

– Human factors

– Reliability concepts

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Where we are going:

• Use the power of the collaborative

– Identify transformational margins

– Involve all stakeholders

– Payment reform

• ? Adapting guidelines developed

elsewhere

Redesigning Redesigning Health CareHealth Care

• DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction)

• High Technology Diagnostic Imaging

• Reliability Centered Surgical Care

• Palliative Care

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Summary

• Guidelines must be in an implementable format

• It takes all stakeholders to make guidelines relevant

• With collaboration, we go

further, faster

• Sustained implementation requires

redesign