Development and application of a generic methodology to assess the quality of clinical guidelines.
BACKGROUND: Despite clinical guidelines penetrating every aspect of clinical practice and health policy, doubts persist over their ability to improve patient care. We have designed and tested a generic critical appraisal instrument, that assesses whether developers have minimized the biases inherent in creating guidelines, and addressed the requirements for effective implementation. DESIGN: Thirty-seven items describing suggested predictors of guideline quality were grouped into three dimensions covering the rigour of development, clarity of presentation (including the context and content) and implementation issues. The ease of use, reliability and validity of the instrument was tested on a national sample of guidelines for the management of asthma, breast cancer, depression and coronary heart disease, with 120 appraisers. A numerical score was derived to allow comparison of guidelines within and between diseases. RESULTS: The instrument has acceptable reliability (Cronbach's alpha coefficient, 0.68-0.84; intra-class correlation coefficient, (0.82-0.90)). The results provided some evidence of validity (Pearson's correlation coefficient between appraisers' dimension scores and their global assessment was 0.49 for dimension one, 0.63 for dimension two and 0.40 for dimension three). The instrument could differentiate between national and local guidelines and was easy to apply. There was variation in the performance of guidelines with most not achieving a majority of criteria in each dimension. CONCLUSIONS: Use of this instrument should encourage developers to create guidelines that reflect relevant research evidence more accurately. Potential users or groups adapting guidelines for local use could apply the instrument to help decide which one to follow. The National Health Service Executive is using the instrument to assist in deciding which guidelines to recommend to the UK National Health Service. This methodology forms the basis of a common approach to assessing guideline quality in Europe. (+info)
Computing for the next millennium.
Computer technology has changed our lives, even that of physicians. In a few years time, a physician can expect to have a new tool by the bedside: a hand-held computer small enough to put into a pocket and powerful enough for all everyday activities, including highly specialized and sophisticated activities such as prevention of adverse drug reactions. The Croatian Academic and Research Network (CARNet) was crucial in bringing the benefits of the information technology to the Croatian scientists. At the Split University School of Medicine, we started the Virtual Medical School project, which now also includes the Mostar University School of Medicine in neighboring Bosnia and Herzegovina. Virtual Medical School aims to promote free dissemination of medical knowledge by creating medical education network as a gateway to the Internet for health care professionals. (+info)
Delivering health information statewide via the Internet in a collaborative environment: impact on individual member institutions.
The Arizona Health Information Network (AZHIN) is a statewide member-driven organization committed to improving access to information for health sciences students and practitioners. Members include several hospitals and hospital systems, an academic health sciences center, and other diverse health care organizations. AZHIN offers its members unlimited Web access to ten well-known health sciences databases. This paper explores the impact that AZHIN has had on its member institutions. A survey asked members to reflect on AZHIN and its possible effects on the visibility of the librarian within the institution, relative dollars spent on AZHIN and range of resources available, Internet connectivity within their institution, access to AZHIN and other Internet resources, teaching, and benefits of collaboration. Results indicated that AZHIN members have access to a wider range of resources than they would otherwise. There are financial savings for some. Internet connectivity and AZHIN membership can provide the librarian with a broadened role and increased visibility. The availability of MEDLINE and other AZHIN resources encouraged some institutions to install Internet connectivity more quickly. Teaching library users has increased. Overall, AZHIN members recognized many benefits of their collaboration. (+info)
UCMP and the Internet help hospital libraries share resources.
The Medical Library Center of New York (MLCNY), a medical library consortium founded in 1959, has specialized in supporting resource sharing and fostering technological advances. In 1961, MLCNY developed and continues to maintain the Union Catalog of Medical Periodicals (UCMP), a resource tool including detailed data about the collections of more than 720 medical library participants. UCMP was one of the first library tools to capitalize on the benefits of computer technology and, from the beginning, invited hospital libraries to play a substantial role in its development. UCMP, beginning with products in print and later in microfiche, helped to create a new resource sharing environment. Today, UCMP continues to capitalize on new technology by providing access via the Internet and an Oracle-based search system providing subscribers with the benefits of: a database that contains serial holdings information on an issue specific level, a database that can be updated in real time, a system that provides multi-type searching and allows users to define how the results will be sorted, and an ordering function that can more precisely target libraries that have a specific issue of a medical journal. Current development of a Web-based system will ensure that UCMP continues to provide cost effective and efficient resource sharing in future years. (+info)
What lessons can be learned for cancer registration quality assurance from data users? Skin cancer as an example.
BACKGROUND: In cancer registration, data cleaning (i.e. amendments made by data users to datasets released by registries) is potentially informative for quality assurance, but generally underreported. AIM: To assess the scope for learning lessons about cancer registration quality assurance from a data user (using skin cancer as the example). METHODS: The main design features were: (i) A descriptive study identifying, qualitatively and quantitatively, the breadth, depth, and impact of quality assurance issues raised by a user cleaning Merseyside and Cheshire Cancer Registry skin cancer data. Errors were rectified and pitfalls for interpretation were identified. (ii) A nested validation of morphology and site coding on random samples of cutaneous malignant melanomas, basal cell carcinomas (BCC), and squamous cell carcinomas. The 33132-record dataset comprised: all registered skin lesions, except metastases; most recorded variables (about patient, lesion, treatment, outcome); for Merseyside and Cheshire residents diagnosed 1970-1991. RESULTS: (i) Ineligible cases represented 0.3% (97/33132), and were detected best by morphology checks. Most quality assurance issues identified related to local custom and practice, staff training, and computerization, being particularly illustrated by problematic BCC registration practice (e.g. records written over unchallenged by range checks; and idiosyncratic use of variables). (ii) Post-cleaning, morphology coding errors were minimal in the random samples. CONCLUSION: There is great scope for data users to contribute to cancer registration quality assurance. Ultimately, the study dataset appeared fit for epidemiological analysis and important quality assurance messages emerged. Shared explicit standard guidelines for data preparation and validation are needed by users, whose insights could and should be better recognized by cancer registries. (+info)
Integration and beyond: linking information from disparate sources and into workflow.
The vision of integrating information-from a variety of sources, into the way people work, to improve decisions and process-is one of the cornerstones of biomedical informatics. Thoughts on how this vision might be realized have evolved as improvements in information and communication technologies, together with discoveries in biomedical informatics, and have changed the art of the possible. This review identified three distinct generations of "integration" projects. First-generation projects create a database and use it for multiple purposes. Second-generation projects integrate by bringing information from various sources together through enterprise information architecture. Third-generation projects inter-relate disparate but accessible information sources to provide the appearance of integration. The review suggests that the ideas developed in the earlier generations have not been supplanted by ideas from subsequent generations. Instead, the ideas represent a continuum of progress along the three dimensions of workflow, structure, and extraction. (+info)
NHSnet in Scottish primary care: lessons for the future.
OBJECTIVE: To evaluate the primary care communications initiative, which introduced NHSnet to primary care in Scotland. DESIGN: Semi-structured telephone interviews, postal questionnaire. SETTING: All 15 Scottish health boards, random sample of 1 in 3 of all Scottish general practices. PARTICIPANTS: Information management and technology managers of health boards, 355 practice managers in the general practices. MAIN OUTCOME MEASURES: Variations between health boards in styles of project management, means of connection to NHSnet, costs to general practices, and training provided. Practices' levels of participation in initiative, initial use of NHSnet, and factors acting as incentives and disincentives to use of NHSnet. RESULTS: 99% of Scottish general practices agreed to participate in initiative. Health boards varied significantly in project management styles (from minimal to total control), the nature of the networks they established (intranets or direct connections), costs to practices (from nothing to pound125 per general practitioner per year), and training provided (from none to an extensive programme). In 56% of practices someone accessed NHSnet at least once a week. Practices varied considerably in amount of internet training received and staff groups targeted and in the intention to provide desktop access to NHSnet through a practice network. CONCLUSION: The initiative has successfully introduced a network that links Scottish general practices, health boards, and hospital trusts. However local variation in this "national" initiative may affect its use in primary care. Health authorities and general practices in England and Wales may wish to note these findings in order to avoid unhelpful variation. (+info)
Exploring information technology adoption by family physicians: survey instrument valuation.
As the information needs of family physicians become more complex, there will be a greater need to successfully implement the technologies needed to manage that information. The ability to stratify primary care physicians can enable the implementation process to be more efficient. This research tested a new instrument on 101 family physicians, and was able to stratify physicians into high, intermediate, and low information technology (IT) usage groups. It is expected that this stratification would allow managers of IT implementation to target specific adoption strategies for each group. The instrument is available from [email protected] (+info)