title: Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice.
abstract: BACKGROUND
  Guidelines are important tools that inform healthcare delivery based on best available research evidence. Guideline use is in part based on quality of the guidelines, which includes advice for implementation and has been shown to vary. Others hypothesized this is due to limited instructions in guideline development manuals. The purpose of this study was to examine manual instructions for implementation advice.
  
  
  METHODS
  We used a directed and summative content analysis approach based on an established framework of guideline implementability. Six manuals identified by another research group were examined to enumerate implementability domains and elements.
  
  
  RESULTS
  Manuals were similar in content but lacked sufficient detail in particular domains. Most frequently this was Accomodation, which includes information that would help guideline users anticipate and/or overcome organizational and system level barriers. In more than one manual, information was also lacking for Communicability, information that would educate patients or facilitate their involvement in shared decision making, and Applicability, or clinical parameters to help clinicians tailor recommendations for individual patients.
  
  
  CONCLUSIONS
  Most manuals that direct guideline development lack complete information about incorporating implementation advice. These findings can be used by those who developed the manuals to consider expanding their content in these domains. It can also be used by guideline developers as they plan the content and implementation of their guidelines so that the two are integrated. New approaches for guideline development and implementation may need to be developed. Use of guidelines might be improved if they included implementation advice, but this must be evaluated through ongoing research.
authors: University Health Network, 200 Elizabeth Street, Toronto, Ontario, Canada. anna.gagliardi@uhnresearch.ca
authors: Anna R
authors: AR
authors: Gagliardi
authors: Melissa C
authors: MC
authors: Brouwers
mesh_terms: D002170:Canada; D005060:Europe; D019983:Guideline Adherence; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D008370:Manuals as Topic; D009520:New Zealand; D017410:Practice Guidelines as Topic