Production, local adaptation and implementation of practice guidelines using evidence-based approaches: the collaboration between Emilia Romagna Regional Agency and the Italian Cochrane Centre

Article type
Authors
Fantini MP, Minozzi S, Rossetti L, Melotti R, Magrini N, Grilli R, Liberati A, Telaro E, Zanetti M
Abstract
The Cochrane Collaboration was launched in 1993, to produce, maintain and disseminate systematic reviews on the effects of health care interventions. This activity is a necessary but not sufficient condition for making evidence-based health care a reality and needs to be integrated with national/local policies aimed at implementing effective interventions. In countries, such as Italy, where a national program for implementing evidence-based health care has not yet been put into action, the local Cochrane Centres has become a methodologic resource for those aimed at improving quality of care through the promotion of utilization of effective and cost-effective interventions. The Regional Health Care Agency of Emilia Romagna has been set up to provide assistance to regional health professionals and administrators with information and tools needed to improve effectiveness and quality of care.

One such effort is represented by the collaboration between the Regional Health Agency of Emilia Romagna and the Italian Cochrane Centre. Five areas for practice guidelines production, local adaptation and implementation have been identified by the Agency according to the public health relevance and health care costs related to the following health problems: a) rational use of routine pre-operatory testing; b) cataract surgery; c) management of hypertension; d) diagnosis and treatment of back pain; e) management of breast cancer. The contribution of the Italian Cochrane Centre to the program includes: a) rigorous critical appraisal in the production and local adaptation phases of the guidelines adopted in the 5 areas above specified; b) assistance in the adoption of implementation strategies shown to be more effective or promising according to the systematic reviews produced by the Cochrane Collaboration Review Group on Effective Practice and Organization of Care (E.P.O.C ).

The program started on September 1997 and is projected up to December 1998. The paper presents and discusses the general features of the collaborative program the methodologists adopted for the different health care problem at issue and illustrates preliminary results for routine pre-operatory testing, cataract surgery and back pain.