Table 2 Methods of guideline-based QI development matched to the steps in the guideline development process

1. Organization, Budget, Planning and Training

Funding: 14 of the 30 approaches were publicly funded, 3 were privately funded, 2 were funded both publicly and privately, 1 did not receive funding and for 10 funding was not reported.

2. Priority Setting

See 5.

3. Guideline Group Membership

Criteria for selection of GDG members were reported in 6 articles. Four articles reported selection of a multidisciplinary panel, including methodological competence, experience in quality improvement, policy decision making and knowledge translation. All 6 articles mentioned clinical expertise for the specific health care topic as competence.

Criteria for selection of QI development panel members were mentioned in 15 articles. Clinical expertise was a criterion in all 15 articles, methodological experience was reported in 6 of the 15 articles. Patients/lay persons were part of three panels. Six reports did not use a formal panel and in 9 articles the criteria were unclear.

4. Establishing Guideline Group Processes

Group processes were not described in any article.

5. Identifying Target Audience and Topic Selection

Fifteen articles reported criteria for selecting the QI topics and the target audience. The criteria, and phrasing of the criteria, varied from article to article. Criteria for topic selection included relevance for the specific care domain (e.g. primary care), quality of care gap, sound evidence base, feasibility, availability, measurability, reliability, validity, regulatory requirements, unknown quality adherence, expected impact on quality of life, costs, work load, disease severity, potential to reduce health inequities and covering all aspects of the care process.

6. Consumer and Stakeholder Involvement

Patients were included in the QI selection process in 9 of the 30 articles.

7. Conflict of Interest (COI) Considerations

Conflicts of interest considerations for the QI development process were not mentioned in any of the papers.

8. (PICO) Question Generation

See item 5 (QI topic selection).

9. Considering Importance of Outcomes and Interventions, Values, Preferences and Utilities

Seventeen articles reported criteria for QI selection. In 9 of these articles patient outcomes, health gain or importance or clinical effectiveness were part of the criteria.

10. Deciding what Evidence to Include and Searching for Evidence

See item 11.

11. Summarizing Evidence and Considering Additional Information

All articles used evidence of guidelines as starting point for the QI development (this was an inclusion criterion). Thirteen articles report additional sources, e.g. literature searches for existing QI sets or available data. In 7 articles QI development was based on multiple guidelines, and in 9 articles QI were developed based on one guideline. In 1 article this was not specified.

12. Judging Quality, Strength or Certainty of a Body of Evidence

8 of the 13 articles which report criteria for selecting recommendations as basis for QI development use level of evidence as a criterion; 3 of the 8 approaches use GRADE and suggest that only strong recommendations should be considered for translation into QI.

13. Developing Recommendations and Determining their Strength

See item 12.

14. Wording of Recommendations and of Considerations of Implementation, Feasibility and Equity

Feasibility was mentioned as a criterion for selecting QI (10 articles). Equity was mentioned once, as a criterion for selecting the topic for which the QI were developed.

15. Reporting and Peer Review

Reporting and peer review of QI were not mentioned.

16. Dissemination and Implementation

Implementation: 12 articles report a QI implementation plan as part of their approach, mostly consisting of development of tools and software, and audits.

18. Updating

Updating of QI was not explicitly mentioned in any of the papers.