The GuideLine Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation

By R. Shiffman, J. Dixon, Cynthia Brandt, Abdelwaheb Essaihi, A. Hsiao, George Michel, Ryan O 'connell, Email Richard, N. Shiffman, R. Edu and 8 more. BMC Medical Informatics Decis. Mak., 2005

347 citations recorded by the source corpus.

BackgroundClinical practice guidelines are not uniformly successful in influencing clinicians' behaviour toward best practices. Implementability refers to a set of characteristics that predict ease of (and obstacles to) guideline implementation. Our objective is to develop and validate a tool for appraisal of implementability of clinical guidelines.MethodsIndicators of implementability were identified from the literature and used to create items and dimensions of the GuideLine Implementability Appraisal (GLIA). GLIA consists of 31 items, arranged into 10 dimensions. Questions from 9 of the 10 dimensions are applied individually to each recommendation of the guideline. Decidability and Executability are critical dimensions. Other dimensions are Global, Presentation and Formatting, Measurable Outcomes, Apparent Validity, Flexibility, Effect on Process of Care, Novelty/Innovation, and Computability. We conducted a series of validation activities, including validation of the construct of implementability, expert review of content for clarity, relevance, and comprehensiveness, and assessment of construct validity of the instrument. Finally, GLIA was applied to a draft guideline under development by national professional societies.ResultsEvidence of content validity and preliminary support for construct validity were obtained. The GLIA proved to be useful in identifying barriers to implementation in the draft guideline and the guideline was revised accordingly.ConclusionGLIA may be useful to guideline developers who can apply the results to remedy defects in their guidelines. Likewise, guideline implementers may use GLIA to select implementable recommendations and to devise implementation strategies that address identified barriers. By aiding the design and operationalization of highly implementable guidelines, our goal is that application of GLIA may help to improve health outcomes, but further evaluation will be required to support this potential benefit.

Subfields: General Health Professions, Public Health, Environmental and Occupational Health

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In General Health Professions

Citations in the corpus

Clinical Practice Guideline: Sudden Hearing Loss (Update) (2019, methodology): “The updated guideline then underwent GuideLine Implementability Appraisal to assess adherence to methodologic standards, to improve clarity of recommendations, and to predict potential obstacles to implementation.(29) The GUG received summary appraisals and modified an advanced draft of the guidelin”
Clinical Practice Guideline (2013, methodology): “American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) staff used the Guideline Implementability Appraisal and Extractor software to appraise adherence of the draft guideline to methodological standards, ensure clarity of recommendations, and predict potential obstacles to im”
Clinical Practice Guideline (2014, positive): “American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) staff used the Guideline Implementability Appraisal and Extractor to appraise adherence of the draft guideline to methodological standards, to improve clarity of recommendations, and to predict potential obstacles to impl”
Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures (2013, background): “GuideLine Implementability Appraisal (GLIA) [132] X I: Implementability [132] None Healthcare”
Clinical Practice Guideline (2013, neutral): “44 The GDG members received summary appraisals in February 2013 and modified an advanced draft of the guideline.”
Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) (2017, methodology): “The updated guideline then underwent GuideLine Implementability Appraisal to appraise adherence to methodologic standards, to improve clarity of recommendations, and to predict potential obstacles to implementation.(38) The guideline update group received summary appraisals and modified an advanced ”
Clinical Practice Guideline (Update): Adult Sinusitis (2015, positive): “The updated guideline then underwent Guideline Implementability Appraisal (GLIA) to appraise adherence to methodologic standards, to improve clarity of recommendations, and to predict potential obstacles to implementation.(34) The GUG received summary appraisals in June and modified an advanced draf”
Clinical practice guideline on diagnosis and treatment of hyponatraemia. (2014, positive): “As part of a research project to evaluate methods for improving guideline development processes, we integrated the GuideLine Implementability Appraisal (GLIA) instrument to optimise the wording of the recommendations [9].”
Guidelines International Network: Toward International Standards for Clinical Practice Guidelines (2012, background): “Most experts agree that trustworthy guidelines are based on high-quality systematic reviews of evidence (2, 51, 103, 119).”
Clinical Practice Guideline: Otitis Media with Effusion (Update) (2016, methodology): “The updated guideline then underwent GuideLine Implementability Appraisal to appraise adherence to methodologic standards, improve clarity of recommendations, and predict potential obstacles to implementation.(64) The GUG received summary appraisals and modified an advanced draft of the guideline ba”