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Kaiser Permanente National Guideline Program (NGP): Implications of IOM CPG Standards

Kaiser Permanente National Guideline Program (NGP): Implications of IOM CPG Standards. 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. Founded in 1945

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Kaiser Permanente National Guideline Program (NGP): Implications of IOM CPG Standards

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  1. Kaiser PermanenteNational Guideline Program (NGP):Implications ofIOM CPG Standards Craig Robbins, MD, MPH KP Colorado-Family Physician Medical Director-KP National Guideline Program

  2. Kaiser Permanente: Largest Non-Profit Health Care Program in the United States 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) Permanente Medical Groups Kaiser Permanente Kaiser Foundation Hospitals Kaiser Foundation Health Plan

  3. Kaiser PermanenteEvidence 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

  4. 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 KP National GuidelineProgram Portfolio

  5. 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

  6. 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

  7. Kaiser Permanente National Guideline Program: Process & Methodology New Clinical Issue ScheduledUpdate • Key to Abbreviations: • CQ Clinical Question • SR Systematic Review • GDT Guideline Development Team • GQ Guideline Quality Committee • NGD KP National Guideline Directors Clinical Questions (CQ) • Overview Existing Guideline? No Yes CQ Match? Existing SR by CQ? Evidence Search Abstract Article Review Inclusion/ Exclusion Data Extraction Critical Appraisal No No Yes Yes Assess Guideline Assess SR Qualitative/ Quantitative Synthesis Assess Evidence Quality Evidence Summary Rationale Recommendations Acceptable? Acceptable? No No Assess Implementability of Recommendations GDT Approval Internal Review GQ NGD Approval Yes Yes New Relevant Studies? National Guideline Yes No Implementation

  8. Kaiser Permanente National Guideline Program: Process & Methodology New Clinical Issue ScheduledUpdate Clinical Questions (CQ) • Acceptable External Guideline • ADAPTE/AGREE Existing Guideline? Yes CQ Match? Yes Assess Guideline Acceptable? GDT Approval Internal Review GQ NGD Approval Yes National Guideline Implementation

  9. Kaiser Permanente National Guideline Program: Process & Methodology New Clinical Issue ScheduledUpdate Clinical Questions (CQ) • No Acceptable External Guideline • Acceptable External Systematic Review • No New Relevant Studies • Modified AMSTAR • GRADE Existing Guideline? No Yes CQ Match? Existing SR by CQ? No Yes Yes Assess Guideline Assess SR Evidence Summary Rationale Recommendations Acceptable? Acceptable? No Assess Implementability of Recommendations GDT Approval Internal Review GQ NGD Approval Yes New Relevant Studies? National Guideline No Implementation

  10. Kaiser Permanente National Guideline Program: Process & Methodology New Clinical Issue ScheduledUpdate Clinical Questions (CQ) • No Acceptable External Guideline • No Acceptable External Systematic Review • Internal Systematic Review • GRADE Existing Guideline? No Yes CQ Match? Existing SR by CQ? Evidence Search Abstract Article Review Inclusion/ Exclusion Data Extraction Critical Appraisal No No Yes Yes Assess Guideline Assess SR Qualitative/ Quantitative Synthesis Assess Evidence Quality Evidence Summary Rationale Recommendations Acceptable? Acceptable? No No Assess Implementability of Recommendations GDT Approval Internal Review GQ NGD Approval National Guideline Implementation

  11. 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

  12. 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

  13. 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

  14. KP National Guideline Program • Questions? • My contact information: Craig Robbins, MD, MPH Email: craig.w.robbins@kp.org Phone: 303-614-1103 Address: 10065 E Harvard Ave, Suite 250 Denver, CO 80231

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