Table 1 Results of the thematic analysis

(1) Evidence-based integrated guideline and QA frameworks

Integrated guideline and QA schemes should be based on the best available evidence (for QA schemes gray literature may be more relevant), usually synthesised and assessed in a systematic review. Evidence reviews should include not only the benefits but potential harms, and other considerations important for decision-making (e.g. GRADE Evidence to Decision (EtD) framework criteria).

(2) Transparency

The steps involved in linking evidence to guideline and quality assurance recommendations by an integrated framework should be clearly documented in a transparent manner.

(3) Declaration of interests and management of conflicts

Both financial and intellectual conflicts of interest for participants in an integrated guideline and QA scheme should be clearly declared and appropriately managed to limit interference in the process.

(4) Selection of QIs

Follow reporting standards on the selection of quality indicators from guideline recommendations [14]. Prioritise patient-important QIs that are measurable, feasible, cannot be easily manipulated and are sensitive to change. First select a small but sufficient number of candidate QIs for review. If QIs are not derived from guideline recommendations, clearly document their source and rationale.

(5) Retirement of QIs

A QI should be retired if, for example, it no longer addresses a quality gap, or it becomes associated with unintended consequences or harm emerges [14].

(6) Risks of integrated guideline and QA Group

We identified potential risks for a joint guideline and QA group, including challenges with group process, focusing on patient-important outcomes, unintended consequences, piloting of quality indicators, and achieving multi-stakeholder engagement. We concluded that the benefits of an integrate scheme outweighed the risks and that these risks would be manageable.

(7) Extension of guideline checklist to incorporate QA considerations

We added steps to the GIN-McMaster Guideline Development Checklist to incorporate unique QA considerations, such as searching for QIs, setting QA priorities, and whether expert subgroups within an integrated process are required to address QA.