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Bringing two worlds closer together: a critical analysis of an integrated approach to guideline development and quality assurance schemes

  • Piggott, Thomas1
  • Langendam, Miranda2
  • Parmelli, Elena3
  • Adolfsson, Jan4
  • Akl, Elie A.1, 5
  • Armstrong, David6, 7
  • Braithwaite, Jeffrey8
  • Brignardello-Petersen, Romina1
  • Brozek, Jan1
  • Gore-Booth, Jolanta9
  • Follmann, Markus10
  • Leś, Zbigniew11
  • Meerpohl, Joerg J12
  • Neamţiu, Luciana3
  • Nothacker, Monika13
  • Qaseem, Amir14
  • Giorgi Rossi, Paolo15
  • Saz-Parkinson, Zuleika3
  • van der Wees, Philip16, 17
  • Schünemann, Holger J.1, 7, 12
  • 1 McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada , Hamilton (Canada)
  • 2 University of Amsterdam, Amsterdam Public Health institute, Amsterdam, Netherlands , Amsterdam (Netherlands)
  • 3 European Commission, Joint Research Centre (JRC), Ispra, Via E. Fermi 2749 – TP 127, Ispra, VA, I-21027, Italy , Ispra (Italy)
  • 4 Karolinska Institutet, Stockholm, Sweden , Stockholm (Sweden)
  • 5 Department of Internal Medicine, American University of Beirut, Beirut, Lebanon , Beirut (Lebanon)
  • 6 Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Canada , Hamilton (Canada)
  • 7 McMaster University, Hamilton, Canada , Hamilton (Canada)
  • 8 Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, 2109, Australia , Sydney (Australia)
  • 9 Digestive Cancers Europe, Brussels, Belgium , Brussels (Belgium)
  • 10 German Cancer Society, Heidelberg, Germany , Heidelberg (Germany)
  • 11 Evidence Prime, Kraków, Poland , Kraków (Poland)
  • 12 Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany , Freiburg (Germany)
  • 13 Institute of Medical Knowledge Management, Association of the Scientific Medical Societies, Frankfurt, Germany , Frankfurt (Germany)
  • 14 American College of Physicians, Philadelphia, PA, USA , Philadelphia (United States)
  • 15 Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy , Reggio Emilia (Italy)
  • 16 Department of IQ healthcare and Rehabilitation, Nijmegen, The Netherlands , Nijmegen (Netherlands)
  • 17 The George Washington University, School of Medicine and Health Sciences, Department of Clinical Research & Leadership, Washington, D.C., USA , Washington, D.C. (United States)
Published Article
BMC Health Services Research
Springer (Biomed Central Ltd.)
Publication Date
Feb 24, 2021
DOI: 10.1186/s12913-020-05819-w
Springer Nature


BackgroundAlthough quality indicators are frequently derived from guidelines, there is a substantial gap in collaboration between the corresponding parties. To optimise workflow, guideline recommendations and quality assurance should be aligned methodologically and practically. Learning from the European Commission Initiative on Breast Cancer (ECIBC), our objective was to bring the key knowledge and most important considerations from both worlds together to inform European Commission future initiatives.MethodsWe undertook several steps to address the problem. First, we conducted a feasibility study that included a survey, interviews and a review of manuals for an integrated guideline and quality assurance (QA) scheme that would support the European Commission. The feasibility study drew from an assessment of the ECIBC experience that followed commonly applied strategies leading to separation of the guideline and QA development processes. Secondly, we used results of a systematic review to inform our understanding of methodologies for integrating guideline and QA development. We then, in a third step, used the findings to prepare an evidence brief and identify key aspects of a methodological framework for integrating guidelines QA through meetings with key informants.ResultsSeven key themes emerged to be taken into account for integrating guidelines and QA schemes: (1) evidence-based integrated guideline and QA frameworks are possible, (2) transparency is key in clearly documenting the source and rationale for quality indicators, (3) intellectual and financial interests should be declared and managed appropriately, (4) selection processes and criteria for quality indicators need further refinement, (5) clear guidance on retirement of quality indicators should be included, (6) risks of an integrated guideline and QA Group can be mitigated, and (7) an extension of the GIN-McMaster Guideline Development Checklist should incorporate QA considerations.DiscussionWe concluded that the work of guideline and QA developers can be integrated under a common methodological framework and we provided key findings and recommendations. These two worlds, that are fundamental to improving health, can both benefit from integration.

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