Implementing multilayered presentation formats in a new generation of trustworthy clinical practice guidelines

Article type
Authors
Brandt L1, Kristiansen A1, Vandvik PO1, Alonso P2, Guyatt G3
1MAGIC-Making GRADE the Irresistible Choice, Norway
2Centro Cochrane Iberoamericano, Instituto de Investigación Biomédica, Barcelona, España
3 Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada
Abstract
Background:
Clinical practice guidelines face challenges with limited availability and usefulness for clinicians at the point of care, often being published as lengthy and cumbersome PDF documents with evidence hidden away in appendixes. Increasing accessibility by structuring content and making guidelines available in optimized presentation formats on a multitude of platforms can facilitate successful dissemination.

Methods:
The MAGIC research and innovation program (www.magicproject.org) has developed a platform (www.magicapp.org) to author, publish and dynamically update trustworthy guidelines developed with the GRADE system. The MAGICapp was large scale tested in an adaptation of the 9th iteration of the American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis, performed by the Norwegian Society of Thrombosis and Hemostasis. We used the MAGICapp to create recommendations in a novel multilayered presentation format, developed and evaluated through an iterative process of brainstorming, sketching, stakeholder feedback and user testing, in collaboration with the DECIDE project (www.decide-consortium.eu).

Results:
We published the Norwegian guideline with 249 recommendations for antithrombotic therapy in November 2013. The guideline is freely available to inhabitants of Norway, accessible online, on smartphones and tablets, with planned integration in the electronic medical records. Clinicians are presented actionable recommendations first, with the option to delve into deeper layers of information: the key information (balance between the desirable and undesirable consequences of an intervention, confidence in the effect estimates, typical values and preferences and costs), rationales describing the reasoning behind the recommendation, practical information (e.g. risk scores, contraindications), evidence profiles with effect estimates and links to references.

Conclusion:
The Norwegian adaptation endeavour demonstrated the feasibility of authoring an entire guideline in the multilayered format which makes the evidence more readily available. We will provide an online demonstration.