Kaiser Permanente National Guideline Program (NGP): Implications of

Kaiser Permanente National Guideline Program (NGP): Implications of April 2009 IOM CPG Standards Netta Conyers-Haynes, Principal Consultant, Communications Craig Robbins, MD, MPH KP Colorado-Family Physician Medical Director-KP National Guideline Program Kaiser Permanente: Largest Non-Profit Health Care Program in the United States Permanente Medical Groups Kaiser Permanente Kaiser Foundation Hospitals Kaiser Foundation Health Plan Founded in 1945 8 regions in 9 states and District of Columbia 8.6 million members (as of 12/09) 15,129 physicians (as of 12/09) 164,098 employees (as of 12/09) KP Care Management Institute (CMI)

KP National Guideline Program (NGP) Kaiser Permanente Evidence Network 15 KP National Evidence-Based Guidelines Supported by full systematic reviews 3.5 staff FTEs dedicated to KP NGP work 1 Principal Consultant, 2 Evidence Analysts, 2 Project Managers 1.5 physician FTEs dedicated to KP NGP work 7 Physician EBM Methodologists External Vendor: Doctor Evidence Search & Data Extraction Technology platform Data repository, analysis & documentation KP National Guideline Program Portfolio Asthma-Adult Asthma-Child/ Adolescent ADHD Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening CAD Depression Diabetes Dyslipidemia (Integrated CVD Risk

Reduction) Heart Failure HIV/STI Screening & Prevention Hypertension Osteoporosis Prostate Cancer Screening IOM Clinical Practice Guideline Standards: Congruent Areas for KP Establishing transparency Management of conflict of interest GDG Composition: Multidisciplinary & balanced CPG-SR intersection Evidence foundations & strength of recommendations Articulation of recommendations Updating IOM Clinical Practice Guideline Standards: Problem Areas for KP GDG composition Patient & public involvement Strategies to increase effective participation of patient and consumer representatives External review No review outside KP No posting for public comment Kaiser Permanente National Guideline Program: Process & Methodology

New Clinical Issue Scheduled Update Clinical Questions (CQ) Key to Abbreviations: CQ Clinical Question SR Systematic Review GDT Guideline Development Team GQ Guideline Quality Committee NGD KP National Guideline Directors Overview Existing No Guideline? Yes CQ Match? No Yes Assess Guideline

No Acceptable? Yes Existing No SR by CQ? Evidence Search Abstract Article Review Inclusion/ Exclusion Data Extraction Critical Appraisal Qualitative/ Quantitative Synthesis Assess Evidence Quality Evidence Summary Rationale

Recommendations Yes Assess SR No Acceptable? Yes Yes New Relevant Studies? Assess Implementability of Recommendations GDT Approval Internal Review GQ NGD Approval National Guideline No Implementation Kaiser Permanente National Guideline Program: Process & Methodology

New Clinical Issue Scheduled Update Clinical Questions (CQ) Acceptable External Guideline ADAPTE/AGREE Existing Guideline? Yes CQ Match? Yes Assess Guideline Acceptable? Yes GDT Approval Internal Review GQ NGD Approval

National Guideline Implementation Kaiser Permanente National Guideline Program: Process & Methodology New Clinical Issue Scheduled Update Clinical Questions (CQ) No Acceptable External Guideline Acceptable External Systematic Review No New Relevant Studies Modified AMSTAR GRADE Existing No Guideline? Yes CQ Match? No Yes Assess Guideline

No Acceptable? Existing SR by CQ? Yes Assess SR Acceptable? Yes New Relevant Studies? Evidence Summary Assess Implementability of Recommendations GDT Approval Rationale Internal Review Recommendations GQ NGD Approval

National Guideline No Implementation Kaiser Permanente National Guideline Program: Process & Methodology New Clinical Issue Scheduled Update Clinical Questions (CQ) No Acceptable External Guideline No Acceptable External Systematic Review Internal Systematic Review GRADE Existing No Guideline? Yes CQ Match? No Yes Assess Guideline

No Acceptable? Existing No SR by CQ? Evidence Search Abstract Article Review Inclusion/ Exclusion Data Extraction Critical Appraisal Qualitative/ Quantitative Synthesis Assess Evidence Quality Evidence Summary Rationale

Recommendations Yes Assess SR No Acceptable? Assess Implementability of Recommendations GDT Approval Internal Review GQ NGD Approval National Guideline Implementation Kaiser Permanente National Guideline Program: Process & Methodology Guideline Implementation National Guideline

Regions (EHR, CDS, Operations) Patient Education Tools (KP.ORG, National Patient Instructions Clinician & Staff Education Tools (Clinical Library) Disease Management Accreditation (NCQA) Key to Abbreviations: EHR Electronic Health Record CDS Clinical Decision Support KP.ORG KP publicly-accessible Internet site NCQA National Committee for Quality Assurance CPG Challenges Infinite needs/finite resources Balancing rigor with efficiency Updating requirements Every 2 years? Dynamic updating, based on evidence & impact?

Patient/public involvement Rigor of external SRs/CPGs Implementation of CPGs at the point of care CPG Opportunities Improved SR & CPG rigor & transparency Common evidence-grading & recommendation strength framework SR & CPG developer collaboration Prioritize & coordinate topics Avoid duplication Target funding Collaboration with performance metric developers KP National Guideline Program Questions? My contact information: Craig Robbins, MD, MPH Email: [email protected] Phone: 303-614-1103 Address: 10065 E Harvard Ave, Suite 250 Denver, CO 80231

Recently Viewed Presentations

  • Implicit approximation can be solved using:  Point iteration

    Implicit approximation can be solved using: Point iteration

    See W&A, p. 95. All known terms are on the RHS; all unknown terms are on the LHS. Let x = y = a 2D The motivation behind the Alternating Direction Implicit Procedure is to keep the coefficient matrix tridiagonal...
  • Supercomputing and Sciences - Marquette

    Supercomputing and Sciences - Marquette

    Grid of tens of thousands networked computers discovers 230402457- 1, the 43rd Mersenne prime, as the largest known prime (9 152 052 digits ) Example 1: Southern oceans heat Modeling (10-minute iterations) 300 GFLOP per iteration 300 000 iterations per...
  • Sociology 510 - CIDE

    Sociology 510 - CIDE

    Structural Equation Models An Overview As with any regression model, structural equation models are causal X Y (X, exogenous variable, causes Y, endogenous variable)
  • C# Control Statements

    C# Control Statements

    Arial Calibri Times New Roman Office Theme CSCI/CMPE 4341 Topic: Programming in Python Chapter 3: Control Structures (Part 1) - Exercises Objectives Multiple Choices Multiple Choices (cont'd) Multiple Choices (cont'd) True/False Statements True/False Statements (cont'd) What are the Precedence of...
  • Chapter 8 ADOLESCENCE 2013 2013 byby Pearson Pearson

    Chapter 8 ADOLESCENCE 2013 2013 byby Pearson Pearson

    Social and Cultural Contexts of Adolescence: Love and Sexuality. Culture influences views on relationships and sexuality. Permissive cultures tolerate adolescent sexuality. Semirestrictive cultures have prohibitions, but not strictly enforced & easily evaded. Restrictive cultures have strong prohibitions (although double standard...
  • A Review on Teaching and Learning Activities and

    A Review on Teaching and Learning Activities and

    Science: Close interaction with the Faculty Student Society …SM4.4 Student Participation Obtaining feedback from students Surveys Graduate capability survey (GCS) SEQ Course evaluation Science Programme specific items in GCS and SEQ Voluntary mid-term classroom feedback (Handbook App 6H) Course evaluation...
  • New Rules Impact on DBE/ACDBE Certification 2011 National

    New Rules Impact on DBE/ACDBE Certification 2011 National

    New Rule's Impact on DBE/ACDBE Certification 2011 National Airport Civil Rights Training Conference Presentation Overview New Rule's Impact on Certification Non-Certifiers Your Responsibilities with Respect to UCP Guidance on Monitoring and Counting DBE Participation Q & A Session New Rule:...
  • Homework Due Friday- Maintenance Sheet 6.23 via quizizz- Game ...

    Homework Due Friday- Maintenance Sheet 6.23 via quizizz- Game ...

    Homework Due Friday- Maintenance Sheet 6.23 via quizizz- Game Code-874852 (6th graders only)Maintenance Sheet 7.23 via quizizz- Game Code- 246778 (7th graders only)Unit Test Friday (cross sections, creating triangles, volume, surface area, and angle relationships). Do you like pringles?. What...