Article type
Abstract
Background: The Agency for Care Effectiveness (ACE) under the Ministry of Health (MOH), Singapore, develops evidence-based clinical practice guidelines, known as ACE Clinical Guidances (ACGs). To enhance ACG uptake and improve practice behaviors, selected ACGs are developed into Appropriate Care Programs (ACPs), which comprise interventions such as educational outreach and webinars, care protocol incorporation, and system reminders. ACPs address practice gaps identified through formative research, data insights, and stakeholder engagements.
Objective: To design and pilot a prioritization framework to select ACGs for development into ACPs with optimal resource allocation.
Methods: The framework design was guided by principles of appropriate and value-based care. ACGs to be prioritized into ACPs should have the highest potential to (1) lead to the delivery of evidence-based practice and shared decision-making and (2) improve health outcomes with no or commensurate cost increases, or lower cost without compromising outcomes. Expertise was sought from relevant stakeholders and implementation experts. There was no consumer involvement.
Results: The framework identified 4 domains:
1. Strength of evidence and clarity of gap: What is the strength of relevant evidence? Is the desired behavior change clearly specified?
2. Importance to health: What is the disease burden? Is the topic of national priority?
3. Opportunity for change: What are health care professionals’ interest level in the topic? Are other stakeholders addressing the same gap?
4. Evaluability: Is the behavior change quantifiable? Are there measurable outcome indicators?
The developed framework was piloted with 7 published ACGs. Three program managers triangulated information from local literature, formative research, and stakeholder inputs before independently assigning scores for each domain using a Likert scale of high, medium, or low. Variances were discussed and a final consensus total score was used to rank all topics.
Conclusion: Prioritization is crucial for efficient allocation of finite government resources, directing efforts toward critical practice gaps with potential for maximum impact, and ensuring sustainable delivery of better health outcomes. The framework will be further refined to improve its usability, equity, and robustness. Potential improvements could include a Delphi approach to scoring and ranking or a weighted scoring system based on relative importance of domains.
Objective: To design and pilot a prioritization framework to select ACGs for development into ACPs with optimal resource allocation.
Methods: The framework design was guided by principles of appropriate and value-based care. ACGs to be prioritized into ACPs should have the highest potential to (1) lead to the delivery of evidence-based practice and shared decision-making and (2) improve health outcomes with no or commensurate cost increases, or lower cost without compromising outcomes. Expertise was sought from relevant stakeholders and implementation experts. There was no consumer involvement.
Results: The framework identified 4 domains:
1. Strength of evidence and clarity of gap: What is the strength of relevant evidence? Is the desired behavior change clearly specified?
2. Importance to health: What is the disease burden? Is the topic of national priority?
3. Opportunity for change: What are health care professionals’ interest level in the topic? Are other stakeholders addressing the same gap?
4. Evaluability: Is the behavior change quantifiable? Are there measurable outcome indicators?
The developed framework was piloted with 7 published ACGs. Three program managers triangulated information from local literature, formative research, and stakeholder inputs before independently assigning scores for each domain using a Likert scale of high, medium, or low. Variances were discussed and a final consensus total score was used to rank all topics.
Conclusion: Prioritization is crucial for efficient allocation of finite government resources, directing efforts toward critical practice gaps with potential for maximum impact, and ensuring sustainable delivery of better health outcomes. The framework will be further refined to improve its usability, equity, and robustness. Potential improvements could include a Delphi approach to scoring and ranking or a weighted scoring system based on relative importance of domains.