2. Determine how to select topics for guideline develop-ment.

3. Describe processes for developing and revising guide-lines based on current evidence and for gaining consen-sus by developers.

4. Describe key challenges facing the guideline developer.METHODS: In this session, we will describe the methods theInstitute for Clinical Systems Improvement utilizes to developand revise guidelines. We will discuss how we garner peerreview of the documents prior to revision, the review of evi-dence, the group process utilized to review the document andthe peer review completed prior to publication. During thissession we will also present methods to reduce bias and obtainconsensus. We will review the process used to develop aimsand measures for improvement that organizations use in theirquality improvement activities. In addition we will discusssome of the current and future challenges of developing anddisseminating guidelines to practicing providers.RESULTS: None provided.DISCUSSION (CONCLUSION): None provided.TARGET AUDIENCE(S):

1. Guideline developer2. Guideline implementer3. Developer of guideline-based products4. Quality improvement manager/facilitator5. Health insurance payers and purchasers6. Medical providers and executives7. Allied health professionals8. Nurses

S29– Attitudes of guideline development groups

to use of GRADE in evidence evaluation and

development of recommendations

Judith Thornton, PhD (Presenter) (National InstituteHealth and Clinical Excellence, Manchester,England, United Kingdom); Tarang Sharma(National Institute Health and Clinical Excellence,Manchester, England, United Kingdom);Victoria Kelly (National Institute Health and ClinicalExcellence, Manchester, England, United Kingdom);Toni Tan (National Institute Health and ClinicalExcellence, Manchester, England, United Kingdom);Jonathan Nyong (National Institute Health andClinical Excellence, Manchester, England, UnitedKingdom); Faisal Siddiqui (National Institute Healthand Clinical Excellence, Manchester, England,United Kingdom); Lynda Ayiku (National InstituteHealth and Clinical Excellence, Manchester,England, United Kingdom)

PRIMARY TRACK: Guideline developmentSECONDARY TRACK: Guideline development groups/panels/committeesBACKGROUND (INTRODUCTION): The GRADE sys-tem is becoming widely used for assessing the quality ofevidence in guidelines. Although we have anecdotal reports

from members of guideline development groups (GDGs) in-volved in NICE guidelines, we have not formally assessedtheir opinions and whether they find the GRADE approachbeneficial. A literature search found no relevant informationfrom other guideline developers. Purpose: to examine whetherGDG members find GRADE useful when reviewing evidenceand formulating recommendations.LEARNING OBJECTIVES (TRAINING GOALS):

1. Determine opinions of members of guideline develop-ment groups to the GRADE approach.

2. Identify the best method of presenting GRADE method-ology to guideline development groups.

METHODS: A short questionnaire was sent to all GDGmembers before the start of evidence assessment with GRADEasking about general knowledge/use of evidence assessmentand GRADE, any preconceptions about GRADE, and whetherthey thought GRADE would help or hinder evidence assess-ment. A follow-up questionnaire was administered after com-pletion of the evidence review with questions about whetherGRADE helped or hindered evidence assessment, the specificbenefits and problems of GRADE, and how GRADE method-ology is best communicated to the GDG members.RESULTS: Four short clinical guidelines were identified forthe pilot study. All 9 GDG members of the first guideline weresent the pre-review questionnaire: All replied (2 patient/care-takers, 8 health-care professionals), response rate 100%. Twomembers had used GRADE previously when developing aNICE guideline and considered it helpful for consistency buthad concerns where few formal studies are available for well-established treatments. Three physicians were aware ofGRADE through the medical literature or implementation ofexisting guidelines.DISCUSSION (CONCLUSION): Follow-up question-naires will be sent at the end of evidence review. The projectwill then be expanded across the full clinical guideline pro-gram. From the results, we hope to determine how we canfurther support the GDGs when introducing GRADE method-ology.TARGET AUDIENCE(S):

1. Guideline developer

S30– Adapting the ADAPTE Framework

Christa Harstall, MHSA (Presenter) (Institute ofHealth Economics, Edmonton, Alberta, Canada);Paul Taenzer, PhD (Calgary Pain Program, Calgary,Alberta, Canada); Carmen Moga, MD (Institute ofHealth Economics, Edmonton, Alberta, Canada);Donna Angus, MHSA (Alberta Innovates - HealthSolutions, Edmonton, Alberta, Canada);Ann Scott, PhD (Edmonton, Alberta, Canada)

PRIMARY TRACK: Guideline developmentSECONDARY TRACK: Guideline development methodsBACKGROUND (INTRODUCTION): The ADAPTEschema outlines a systematic approach for adapting and con-textualizing guidelines. The Alberta Ambassador Program in-

25Oral Presentation

dependently developed a similar framework. We explored thekey differences between these two frameworks.LEARNING OBJECTIVES (TRAINING GOALS):

1. Identify possible improvements to the ADAPTE process.2. Examine a case study on the practical application of

guideline adaptation.METHODS: The Ambassador Program formed a multidisci-plinary partnership of clinicians, health technology assessmentresearchers, and other key stakeholders to construct an evi-dence-based, provincial guideline on low back pain manage-ment for use by all professionals in community practice.RESULTS: The Ambassador Program differed from theADAPTE framework as follows.● Selecting participants. A novel process was used to recruit

guideline development group (GDG) members.● Committee structures/responsibilities. A more complex

committee structure, with altered responsibilities, wasused to reduce the GDG workload and improve stake-holder engagement.

● Using AGREE. The instrument was modified to reducethe ambiguity and subjectivity of item scoring.

● Summarizing guideline content. Standardized evidenceinventory tables were created to highlight convergent anddivergent recommendations and summarize the type andquantity of supporting evidence for each seed guidelinerecommendation.

● Evaluating underlying evidence. A systematic processwas developed to review additional research evidencewhen necessary.

● Defining recommendations. A process was developed toensure a standardized definition of the final guidelinerecommendations (e.g., what constituted a “do” recom-mendation) and transparently and systematically displaythe source of final recommendations.

● Piloting the guideline. A variety of methods were used,including a patient focus group and face-to-face meetingswith professional associations.

DISCUSSION (CONCLUSION): The main steps and se-quence of the adaptation process were similar between the twoframeworks, although the Ambassador Program incorporatedmore involved strategies to overcome unforeseen difficulties atkey points in the process. These “adaptations” of the ADAPTEframework augmented rather than attenuated the process.TARGET AUDIENCE(S):

1. Guideline developer2. Guideline implementer3. Developer of guideline-based products

S31– Balance@Work: A combined guideline and

research project on prevention of weight gain

among employees

Carel Hulshof, PhD (Presenter) (Centre ofExcellence, NVAB, Utrecht, Netherlands);Lisanne Verweij, MSc (EMGO Institute for Healthand Care Research, VUmc, Amsterdam,Netherlands); Karin Proper, PhD (EMGO Institute for

Health and Care Research, VUmc, Amsterdam,Netherlands); Andre Weel, PhD (Centre ofExcellence, NVAB, Utrecht, Netherlands);Willem van Mechelen, PhD (EMGO Institute forHealth and Care Research, Amsterdam,Netherlands)

PRIMARY TRACK: Guideline developmentSECONDARY TRACK: Guideline development methodsBACKGROUND (INTRODUCTION): Occupational phy-sicians (OPs) may be involved in health promotion activities.Due to a lack of knowledge and evidence- and practice-basedmethods, these activities are hardly being implemented by OPsto date. The aim of the Balance@Work project is to develop,evaluate, and implement a guideline on prevention of weightgain among employees by combining a guideline developmentand research approach.LEARNING OBJECTIVES (TRAINING GOALS):

1. Identify alternative method for guideline development inoccupational and public health domain.

2. Assess the use of an intervention mapping protocol as aninnovative element in guideline development.

3. Assess the use of an RCT to evaluate the cost-effective-ness of a draft guideline in an extended guideline project.

METHODS: Following the process of the Netherlands Soci-ety of Occupational Medicine (NVAB) and using an Interven-tion Mapping (IM) protocol, a draft guideline was developedbased on literature, interviews with employers, focus groupswith employees, and input from a guideline developmentgroup of OPs and lifestyle experts. The draft guideline isevaluated in a randomized controlled trial. OPs in the inter-vention group apply the draft guideline to eligible workersduring 6 months. OPs in the control group provide care asusual. Measurements at baseline and 6, 12, and 18 monthsthereafter include waist circumference, daily physical activityand dietary behavior and, additionally, productivity, absentee-ism, and cost-effectiveness.RESULTS: The developed draft guideline gives recommen-dations for OPs how to advise employers to promote employ-ees’ physical activity and diet, and counsel employees to adopta physically active and healthy diet behavior. The effectivenessis currently being evaluated in a RCT among 20 OPs, including400 workers. If proven effective, this guideline will be imple-mented by the NVAB.DISCUSSION (CONCLUSION): Combining a guidelinedevelopment project with an RCT leads to a substantial exten-sion of the development period. In complex or relatively newtopics in the field, this, however, may be a valuable approach.The time lost in the development process may be regainedbecause of the gathered experience with implementation of thedraft guideline.TARGET AUDIENCE(S):

1. Occupational and public health physicians2. Clinical researcher3. Guideline developer4. Guideline implementer

26 Otolaryngology–Head and Neck Surgery, Vol 143, No 1S1, July 2010