A multi-layered approach to base decisions in systematic reviews and the GRADE approach: The Chilean National Guideline Program Case

Tags: Oral
Rodriguez F1, Herrera P2, Burdiles P2, Kraemer P2, Sepulveda D2, Pimentel L2, Quiñelen E2, Contreras M2, Pesso BP3, Olave P3, Salas F3, Rojas DR3, Zecchetto S3, Caba F3, Camus J3, Ganchozo N3, Bobadilla MB3, Vasquez V3, Madrid E4, Perez-Bracchiglione J4, Meza N4, Garnham R4, Sanchez L4, Neumann I2
1Universidad San Sebastian , 2Ministerio de Salud de Chile, 3Universidad San Sebastian, 4Universidad de Valparaíso

Background: before 2016, clinical guidelines developed by the Ministry of Health were not based on systematic reviews. Also, panels were not multidisciplinary and the recommendations were based mainly on expert opinion. As result, studies assessing the quality of recommendations showed that most were not trustworthy.

In 2016, we introduced a multilayered intervention at five levels. First, we changed the composition and operation of guideline panels. Panels now included methods experts, patients and payers’ representatives. Additionally, methodologists had the responsibility of conducting the process and drafting the final recommendations. Second, a policy for managing conflict of interest was enforced. Third, all the recommendations were based on systematic reviews of the evidence about the effect of the intervention, patients’ values and preferences, and resource utilization data. Fourth, the process of developing recommendations was conducted and explicitly reported following the GRADE approach and Evidence to Decision Tables. Finally, recommendations were published in an online platform friendly to mobile devices.

Objectives: to evaluate the trustworthiness of recommendations developed after a multi-layered intervention based on systematic reviews and the GRADE approach.

Methods: teams of two investigators blindly and independently assessed all the recommendations published by the Ministry of Health on 2016 and afterwards used the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation). Disagreements were recorded and resolved by consensus. We compared the results of this evaluation with a previous study conducted by us, in which we evaluated the quality of recommendations published before 2016.

Results: this study is ongoing and the results will be presented at the Colloquium.

Conclusions: preliminary data suggest that the multilayered intervention has significantly increased the trustworthiness of recommendations.

Patient or healthcare consumer involvement: although patients and healthcare consumers were not involved in this study, they had an active role in the interventions reported. Specifically, patients and health consumers were included in guideline panels as voting members.