Gin2012 adapte22ppt

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Power point presented during the Panel session: Guideline Adaptation: different methods, different experiences, mapping a way forward; 9th G-I-N International Conference, Berlin, Germany 22nd-25th August 2012 by Dr Yasser Sami Abdel Dayem Amer representing the Alexandria CEBCPGs and Healthcare Quality Directorate of Alexandria University Hospitals with Prof. Dr. Tarek Omar, Professor of Pediatrics, Alexandria Faculty of Medicine

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Gin2012 adapte22ppt

  1. 1. Alexandria University Hospitals Healthcare Quality DirectorateCenter for Evidence-Based Clinical Practice Guidelines (AUH – HCQD, CEBCPGs) (Founded Nov. 2008)Member of Guidelines International Network (G-I-N) (Since May 2009)
  2. 2. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines
  3. 3. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines
  4. 4. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines First Workshop in Egypt Adaptation of CPGs - 2009 (AFM-GIN-ADAPTE)
  5. 5. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Develop Adapt AdoptRead
  6. 6. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines *12 M.Sc. Theses plus 1 Ph.D. thesis to produce 13 Adapted EBCPGs4 Finalized Adapted CPGs by CEBCPGs, HCQD-AUHs through MSc Theses(till 3/2012) in PEDIATRICS DEPT.:1- Treatment of Acute Childhood Asthma in ER - AUCH: Dr. Yasser Sami Amer (Finalized, Approved ,Disseminated & Implemented).2- Treatment of Positioning & Attachment Breast Feeding Problems in BFCC - AUCH: Dr. GeorginaRamsis (Finalized & Approved).3- Triage and Acuity Scale in A & E Dept., AMUH: Dr. Mary Christeen Nabiel Sharobeem (Finalized,Approved & Disseminated ) – the only thesis outside the Pediatrics Dept.4- Treatment of HIE in Neonates in NICU: Dr. Walid Gamal AbdelKhaliq(Finalized & Approved).9 Adapted CPGs in progress by Pediatrics Dept. & CEBCPGs, HCQD-AUHs throughMSc/PhD Theses (till 8/2012):1. Treatment of ADHD in children in AUCH: Dr. Mariana Iskander Amin (Finalization Phase).2. Diagnosis of acute attack of seizures in AUCH: Dr. Soheir Farouk AbdelSalam (Set Up Phase).3. Treatment of acute attack of seizures in AUCH : Dr. Islam Yousry A.Moneium (Set Up Phase).4. Management of Epilepsy in children in AUCH: Dr. Shimaa Anwar (Set Up Phase)5. Treatment of Childhood Autism in AUCH: Dr. Farioz Ibrahim (Set Up Phase).6. Management of Acute Bacterial Meningitis in AUCH: Dr Mariam Adly (Set Up Phase).7. Treatment of Chronic Asthma in AUCH: Dr. Reem Galal Ghazal (Set Up Phase).8. Treatment of Community Acquired Pneumonia in AUCH: Dr. Zobaida Eltazmany (Set Up Phase).9. Treatment of Allergic Rhinitis in AUCH: Dr. Shahinaz (Set Up Phase).
  7. 7. 4 Finalized Adapted CPGs
  8. 8. Alexandria University Hospitals HCQD - CEBCPGsAdapted ADAPTE Methodology for EBCPGs Adaptation Proposed by YASSER AMERSupervised & Approved by MAHMOUD ELZALABANY, TAREK OMAR & AFAF IBRAHIM TheIs Adaptablemethods are adapted from the proposed original ADAPTE Process (The ADAPTE according to local settingsCollaborations (2009); The ADAPTE Process: NMC 2009 Resource Toolkit for Guideline Adaptation. (Version 2.0)
  9. 9. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines These CEBCPGs Methods consist of two main parts; Part One:Cross-sectional/ or retrospective study survey via self-administered Questionnaire &/or Interview of the targethealthcare Professionals & Medical Records of targetPopulation (patients) for Assessment of the currentsituation of practice in the selected healthcare context; to identify/select high priority health topic(s) for CPG Adaptation & to justify the need for producing an CPG for this selected topic and expected benefit and outcome for disseminating and implementing this adapted CPG.
  10. 10. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Part Two The Adapted ADAPTE Methodology ©Copyright ADAPTE 2007
  11. 11. Adaptation Phase Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesWe identified 3 main ADAPTE steps:- Health Questions (PIPOH) AGREE Instrument (I, II, III) Assess source CPGs quality External Review (Consensus)
  12. 12. Adaptation Phase Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesADAPTE Tools Alternatives to:-
  13. 13. Adaptation Phase Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Original ADAPTE Tool Adapted ADAPTE (Alternative)Assess the source CPGs AGREE II Instrumentconsistency: Evaluation of Domain 3. Rigour ofSearch/selection of evidence & Development scoresScientific Validity of CPGs/Consistency between evidence, its Considerinterpretation and recommendations incorporatingAssess Acceptability/ AGREE II InstrumentApplicability of Domain 5. Applicability scoresrecommendations & Domain 2. Stakeholder Involvement scores;
  14. 14. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines SolutionsIf CPGs retrieved were low-quality (No clear methodology, levels ofevidence and grades of recommendations & the developers did not reply toany of our emails to receive them; The panel can do Critical Appraisalof the reference studies (articles) and classify their evidenceaccording to type of study (e.g. Systematic reviews, MAs, RCTs,…etc.)and /or create Evidence-tables (e.g. like what the panel did in Triage &HIE CPG Adaptation). Then the panel can decide at this point herewhether to pursuit for CPG development or adaptation.(? may also consider concept)
  15. 15. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Lessons for CPGsDevelopers, Adapters, Implementers and 7 Users
  16. 16. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Lessons learned1) Health Topics for CPG Adaptation & Implementation should be selected based on Cross- sectional study surveys for local Healthcare Professionals (e.g. Needs Assessment, Review of Medical Records, Self-administered Questionnaires and Interviews) .
  17. 17. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Lessons learned (cont’d)2) Adaptation of CPGs as a valid alternative to de novo development has the benefit of reduction of the costs/ time, avoid practice variations, consider availability of resources, respect difference between patient populations, local policies, and practice patterns and promote the sense of ownership among target users.
  18. 18. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Lessons learned (cont’d)3) Examples of Successful CPGs Implementation Strategies; i) For Practitioners: Tools designed to facilitate behavioral/practice changes (e.g. Posters & Brochures of Clinical algorithms & Flow charts), Educational material (printed/ electronic), Educational meetings (e.g. conferences, lectures & workshops) & Local Clinical Champions; and ii) For Patients/ Parents/Carers: Education materials (printed and electronic) & meetings.
  19. 19. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Official website:http://www.alexmed.edu.eg/?page_id=1278 Last accessed 8/2012
  20. 20. https://www.facebook.com/pages/Alexandria-Center-for-Evidence-Based-Clinical- Practice-Guidelines/124300224291530?ref=hl
  21. 21. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines The Final Adapted CPG documentThe FinalAdaptedCPGdocument FIRST OF ITS KIND IN EGYPT AUCH, AFM & AUHs
  22. 22. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines The Final Adapted CPG document 47 pages document (with added tools). Reviewed by Pediatric Repir., Allergy & Immuno. Unit, AFM Staff members. Approved by Pediatrics Dept. & AFM Councils
  23. 23. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesImplementations Tools for the Adapted CPG
  24. 24. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesI-1. Clinical algorithms (for < 2 yrs)
  25. 25. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesI-2. Clinical algorithms (for 2- 5 yrs)
  26. 26. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesI-3. Clinical algorithms (for > 5 yrs)
  27. 27. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesII-1. Asthma Action Plan (English)
  28. 28. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesII-2. Asthma Action Plan (Arabic)
  29. 29. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesIII- Patient Guide-Inhalers (Poster- Arabic)
  30. 30. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesIV- Patient information (Arabic)
  31. 31. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Lessons learned (cont’d)4) The Finalized Adapted CPGs should be included in the Training Curricula of both Undergraduate and Postgraduate Medical Students and as a part of any Healthcare Facility’s Policy for Residency Training.
  32. 32. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Lessons learned (cont’d)5) Follow up of the implementation, dissemination and updating of the CPG as a vital step in the process of Adaptation (the living CPG concept).
  33. 33. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Lessons learned (cont’d)6) Promote and Improve National (e.g. through local different HCFs/ sectors) and International (e.g. through G-I-N) Collaboration in CPGs activities.
  34. 34. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice Guidelines Lessons learned (cont’d)7) Coordinate, organize and promote Establishment & Activation of; ‘Multidisciplinary’ CPGs Committees/ Adaptation Working groups from the Staff of all Clinical Departments of selected HCFs (to involve practitioners & patients); and of a National CPGs Database(s), enabling the systematic search, comparison and dissemination of CPGs from all members of Committees/ WGs.
  35. 35. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesProf. Dr. Nabil DowidarProfessor of General Surgery , MRIHead, Alexandria Center for EBM, MRIFounding Member, Health Governance Unit, MRIFormer Dean, MRIMedical Research Institute (MRI)Prof. Dr. Afaf IbrahimProfessor of Public Health, Social & Preventive Medicine, AFMHead, Community Medicine Dept.Director, CEBCPGs , HCQD-AUHs
  36. 36. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesDr. Yasser Sami AmerM.Sc. Pediatrics, M.Sc. Healthcare InformaticsHospital Clinical Guidelines & Pathway GeneralCoordinator, CEBCPGs, HCQD-AUHs, Primary Contact Person for G-I-NDr. Hossam DhorghamM.Sc. Pediatrics, M.Sc. Healthcare ManagementFormer Healthcare Quality Coordinator, HCQD-AUHsFormer Head, Accreditation & Licensure Directorate, HCQD-AUHsEng. Ahmed MouradyCommunication & Electronics EngineerE-Learning Consultant,Former Local Project Manager, Modernization of AUHs in Smouha
  37. 37. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesProf. Dr. Tarek Omar Professor of Pediatrics & Ped. Neurology, AFM General Supervisor CEBCPGs & HCQD-AUHs. Former Head, AUHs Sector
  38. 38. Healthcare Quality Directorate - Alexandria University Hospitals Center for Evidence-Based Clinical Practice GuidelinesProf. Dr. Mahmoud El-ZalabanyProfessor of Pediatrics & Ped. Respiratory, Allergy & Immunology Former Dean, AFM Former Chairman, AUHs Board
  39. 39. Healthcare Quality Directorate - Alexandria University Hospitals Bernard Center for Evidence-Based Clinical Practice Guidelines Magali Bernand Virginia Remy- Moyer StockingerAcknowledgement & due gratitude to all members of G-I-N & ADAPTE for their continuous support & sincere guidance Najoua throughout this work especially …. Rachel Beatrice Mlika- Voellinger Fervers Cabanne Ali El- Sara Ghorr Twadle Philip van der Wees
  40. 40. Dr. Yasser Sami Amer MSc Pediatrics, MSc HC Informatics Founding Member, G. Coordinator, CEBCPGs, HCQD-AUHs

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