gms | German Medical Science

Background: The cost and resource intensity of guideline development and updating is increasingly leading complex healthcare delivery organizations to adopt models of collaborative guideline development that focus on centralized or 'global' production of evidence reviews, and contextualization of recommendations and implementation efforts to fit local differences.

Context: A large, U.S.-based integrated healthcare system with centralized evidence services and eight independent regions developed and implemented a guideline for colorectal cancer screening interventions using a global evidence/local implementation model.

Description of best practice: Graded evidence summaries were developed by a centralized analytic unit, and recommendations developed by a guideline team with representation from each independent region. Regions selected interventions for implementation based on local operational issues. In one large region with more than 3 million patients, interventions aimed at the practitioner, patient and systems levels were tailored to implement recommendations for annual fecal immunochemical testing (FIT) or colonoscopy screening. Practitioner interventions included a combination of passive and active strategies, including basic knowledge dissemination (distribution of guidelines via e-mail and online), point-of-care electronic prompts, and workflow support. Patient-level interventions included point-of-care education, inreach/outreach activities, and mass mailing of FIT kits to patients' homes. System-level interventions included centralized patient outreach letters and calls, computerized decision support, a safety net system and bimonthly data analysis to monitor performance. Consistent increases in screening rates were observed over a three-year period.

Lessons: A model of guideline development focused on globalizing the evidence and localizing implementation can be an efficient and effective practice for healthcare delivery organizations.