Theme | Description |
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(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. |