Evidence Resources /

Notes on the Adaptation / Synthesis of Guidelines

NZGG recommends the following process should be used by each guideline development team when adapting overseas evidence-based guidelines.

The steps:

1. Find the guidelines –conduct a search and identify these.  Look at the US Guidelines Clearing House www.guidelines.gov or www.guidelines-international.net
   
   
2. Appraise the guidelines (using AGREE instrument) for quality and process
   
   
3. Analyse the content for scope and applicability
• Same health settings, professional groups?
• Same patients, consumers?
• Same interventions?
• Same outcomes?
  
  
4. Get permission to use the relevant parts (evidence tables and search strategies) from guidelines teams and writers. NZGG is in contact with most overseas guideline organisations so can be asked to facilitate this.
   
   
5. Look at the gaps in the issues covered in the overseas guidelines
• Any clinical questions not covered?
  
  
6. Look at the sources of evidence
• Is the search strategy available?
• Are there any evidence tables?
• Are the evidence statements and recommendations referenced?
  A number of other guideline organisations are prepared to make these available.
  
  
7. Look at the quality of recommendations
• Are the recommendations valid and is the grading correct?
• Pick a few controversial topics to review how these were dealt with
  
  
8. Re-run the search strategy to include the questions selected
• To include literature at least one year prior to the date of publishing
• Check if any large study would radically change the recommendations
  
  
9. Implementation planning
• Redesign the implementation plan to meet local circumstances

THE TIMING AND PROCESS

• Meeting 1:  (feasibility of a guideline synthesis)
• Present an appraisal and analysis of current guidelines
• Present the evidence tables, recommendations and linked references
• Assess the quality of recommendations
• Team to discuss gaps and clinical questions
• Team to discuss issues specific to New Zealand
  
  
• Meeting 2:
• Present results of re-run search and new evidence
• Rewrite and regrade recommendations
• Prepare draft of the guideline
• Discuss implementation at local level, draft implementation plan.

Send out the draft for comment and peer review – use AGREE Instrument www.agreecollaboration.org

• Final teleconference:
• The group reconvenes by teleconference to consider the comments received from consultation and peer review.

The final guideline and summary supporting documentation is revised by a small sub group. Once it has been completed it is sent out for endorsement by stakeholder groups.

CJF = Considered Judgment Form