The European Society of Human Reproduction and Embryology guideline for the diagnosis and treatment of endometriosis: an electronic guideline implementability appraisal.
BACKGROUND
Clinical guidelines are intended to improve healthcare. However, even if guidelines are excellent, their implementation is not assured. In subfertility care, the European Society of Human Reproduction and Embryology (ESHRE) guidelines have been inventoried, and their methodological quality has been assessed. To improve the impact of the ESHRE guidelines and to improve European subfertility care, it is important to optimise the implementability of guidelines. We therefore investigated the implementation barriers of the ESHRE guideline with the best methodological quality and evaluated the used instrument for usability and feasibility.


METHODS
We reviewed the ESHRE guideline for the diagnosis and treatment of endometriosis to assess its implementability. We used an electronic version of the guideline implementability appraisal (eGLIA) instrument. This eGLIA tool consists of 31 questions grouped into 10 dimensions. Seven items address the guideline as a whole, and 24 items assess the individual recommendations in the guideline. The eGLIA instrument identifies factors that influence the implementability of the guideline recommendations. These factors can be divided into facilitators that promote implementation and barriers that oppose implementation. A panel of 10 experts from three European countries appraised all 36 recommendations of the guideline. They discussed discrepancies in a teleconference and completed a questionnaire to evaluate the ease of use and overall utility of the eGLIA instrument.


RESULTS
Two of the 36 guideline recommendations were straightforward to implement. Five recommendations were considered simply statements because they contained no actions. The remaining 29 recommendations were implementable with some adjustments. We found facilitators of the guideline implementability in the quality of decidability, presentation and formatting, apparent validity, and novelty or innovation of the recommendations. Vaguely defined actions, lack of facilities, immeasurable outcomes, and inflexibility within the recommendations formed barriers to implementation. The eGLIA instrument was generally useful and easy to use. However, assessment with the eGLIA instrument is very time-consuming.


CONCLUSIONS
The ESHRE guideline for the diagnosis and treatment of endometriosis could be improved to facilitate its implementation in daily practice. The eGLIA instrument is a helpful tool for identifying obstacles to implementation of a guideline. However, we recommend a concise version of this instrument.
Department of Obstetrics & Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. w.nelen@obgyn.umcn.nl
Lotte J E W
LJ
van Dijk
Willianne L D M
WL
Nelen
Thomas M
TM
D'Hooghe
Gerard A J
GA
Dunselman
Rosella P M G
RP
Hermens
Christina
C
Bergh
Karl G
KG
Nygren
Arnold H M
AH
Simons
Petra
P
de Sutter
Catherine
C
Marshall
Jako S
JS
Burgers
Jan A M
JA
Kremer
D004715:Endometriosis / Q000175:diagnosis* / Q000628:therapy; D005060:Europe; D005260:Female; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D016730:Program Development; D012955:Societies, Medical; D011795:Surveys and Questionnaires
BMJ. 1997 Aug 16;315(7105):418-21
9277610
Hum Reprod. 2006 Aug;21(8):2103-9
16601007
Med Care. 1994 Mar;32(3):202-13
8145598
J Am Med Inform Assoc. 2004 Sep-Oct;11(5):418-26
15187061
Eur Respir J Suppl. 2003 Jan;39:23s-29s
12572698
Hum Reprod. 2005 Oct;20(10):2698-704
15980014
Hum Reprod. 2007 Jun;22(6):1506-12
17376819
Hum Reprod. 2007 May;22(5):1298-303
17317720
Hum Reprod. 2007 Oct;22(10):2665-72
17664242
Int J Qual Health Care. 2006 Jun;18(3):167-76
16766601
Neth J Med. 2005 Jun;63(6):188-92
16011009
J Obstet Gynaecol. 2003 Jul;23(4):397-401
12881081
Lancet. 2002 Jul 13;360(9327):151-9
12126838
BMJ. 1998 Aug 15;317(7156):465-8
9703533
BMC Med Inform Decis Mak. 2005 Jul 27;5:23
16048653
JAMA. 1999 Oct 20;282(15):1458-65
10535437
CMAJ. 2007 Nov 6;177(10):1221-6
17984472
Qual Saf Health Care. 2009 Oct;18(5):385-92
19812102
Med Care. 2001 Aug;39(8 Suppl 2):II2-45
11583120
Qual Saf Health Care. 2009 Apr;18(2):157-9
19342533
Lancet Oncol. 2003 Mar;4(3):139-40
12623358
Qual Saf Health Care. 2003 Feb;12(1):18-23
12571340
Fertil Steril. 2005 Feb;83(2):275-83
15705363
Hum Reprod. 2005 Dec;20(12):3301-6
16055463
Lancet. 2003 Oct 11;362(9391):1225-30
14568747
Hum Reprod. 2004 Dec;19(12):2689-94
15513984
Ann Intern Med. 2003 Sep 16;139(6):493-8
13679327
Cochrane Database Syst Rev. 2000;(2):CD000349
10796531
Hum Reprod. 2008 Aug;23(8):1786-92
18480089
Int J Qual Health Care. 2003 Feb;15(1):31-45
12630799
Lancet. 1993 Nov 27;342(8883):1317-22
7901634
BMJ. 1993 Jun 26;306(6894):1728-31
8280213
BMJ. 1999 Feb 20;318(7182):527-30
10024268