Online Dissemination of Clinical Practice Guidelines as Narrative - PowerPoint PPT Presentation

Tekst Online Dissemination of Clinical Practice Guidelines as Narrative Texts and Structured Pathways A Case Study with the Treatment of Type 2 Diabetes eroussi 1 , 2 , H. Falco ff 3 , V. Ertel-Pau 4 , V. Raimond 4 , B. S´ J. Bouaud 1 , 5 1 Sorbonne Universit´ es, UPMC Univ Paris 06, UMR S 1142, LIMICS, Paris, France ; INSERM, U1142, LIMICS, Paris, France ; Universit´ e Paris 13, Sorbonne Paris Cit´ e, LIMICS, (UMR S 1142), Bobigny, France 2 AP-HP, Hˆ op. Tenon, D´ epartement de sant´ e publique, Paris, France; APREC, Paris, France 3 Universit´ e Paris Descartes, Sorbonne Paris Cit´ e, D´ epartement de m´ edecine g´ en´ erale, Paris, France; SFTG, Paris, France 4 Haute Autorit´ e de Sant´ e, Saint-Denis-La-Plaine, France, France 5 AP-HP, DRCD, Paris, France MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 1/16

Context & Objectives Method Results Discussion & Conclusion Clinical practice guidelines and CDSSs Clinical practice guidelines (CPGs) Promotion of Evidence-based medicine Recommendations for patients with specific conditions Support practitioners’ decisions Publication as textual documents Low impact on clinical practices Guideline-based clinical decision support systems (CDSSs) Deliver patient-specific recommendations E ffi cient tool to promote CPG implementation Potential impact on clinical pratices MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 2/16

Context & Objectives Method Results Discussion & Conclusion Problem and objectives CPG content modelling from text - formalization Ambiguities, incompleteness Delay in CDSS delivery Static CPG textual knowledge MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 3/16

Context & Objectives Method Results Discussion & Conclusion Problem and objectives CPG content modelling from text - formalization Ambiguities, incompleteness Delay in CDSS delivery Static CPG textual knowledge Aim of the work Simultaneous CPG modelling and authoring of textual (CPGs) and structured formats (knowledge base) Beneficial for both productions Synchronous dissemination of textual and structured formats Audience analysis User attitudes - online questionnaire MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 3/16

Context & Objectives Method Results Discussion & Conclusion Problem and objectives CPG content modelling from text - formalization Ambiguities, incompleteness Delay in CDSS delivery Static CPG textual knowledge Aim of the work Simultaneous CPG modelling and authoring of textual (CPGs) and structured formats (knowledge base) Beneficial for both productions Synchronous dissemination of textual and structured formats Audience analysis User attitudes - online questionnaire Management of type 2 diabetes (T2D-CPGs) Collaboration with French National Health Agency (HAS) Update of 2006 CPGs Structured representation: RecosDoc-diab` ete MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 3/16

Context & Objectives Method Results Discussion & Conclusion CPG authoring method A HAS-controlled standard Stratégie médicamenteuse du contrôle glycémique du diabète de type 2 methodology Working group - 1 HAS project leader and 2 medical project managers RECOMMANDATION DE BONNE PRATIQUE Stratégie médicamenteuse du contrôle glycémique du diabète de type 2 First draft based on literature Méthode « Recommandations pour la pratique clinique » review RECOMMANDATIONS 5 to 6 WG meetings Janvier 2013 Each proposed recommendation is voted Grading: EBM (A, B, C) or PA MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 4/16

Context & Objectives Method Results Discussion & Conclusion CPG formalization WG1: project presentation Work with 1 medical project manager (H. Falco ff ) Formalization of each intermediate HbA1c
>
therapeu/c
target

 version of CPGs and
pa/ent
under
Me4ormin
 Sulfonylurea
contraindicated
 Structuration as a decision tree Yes

 No

 Grading: EBM, PA, or ExpB HbA1c
near
target
 • Me4ormin
+
Sulfonylurea
 Yes
 No
 Abstractions, ambiguities, Overweight
 • Me4ormin
+
Alpha
glucosidase
inhibitors
 incompleteness reported to WGs • Me4ormin
+
DPP4‐inhibitors
 No

 Yes

 • Me4ormin
+
Insulin
 • Me4ormin
+
GLP1‐receptors
agonists
 
 A browsable knowledge base Last WG: presentation of RecosDoc-diab` ete Synchronous online publication MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 5/16

Context & Objectives Method Results Discussion & Conclusion Online questionnaire on RecosDoc-diab` etes Short, open, anonymous questionnaire 5 questions related to the delivery of structured CPGs Context of use of the system Ease of use Usefulness for practice Intention to re-use Usefulness for understanding CPGs Free comments or suggestions Respondent profiles Profession Years of practice Type of practice MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 6/16

Context & Objectives Method Results Discussion & Conclusion Double format publication Textual CPGs production 31 recommendations Some improvements Structured version - RecosDoc-diab` ete First version of the knowledge base 89 criteria 805 clinical profiles: 2 EBM, 37 PA, 766 ExpB Expert-based profiles not endorsed by HAS Second version 30 criteria 88 clinical profiles: 2 EBM, 77 PA, 0 ExpB Press conference by HAS (Feb. 13 th , 2013) T2D-CPGs dedicated page on HAS website Link to RecosDoc-diab` ete MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 7/16

Context & Objectives Method Results Discussion & Conclusion MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 8/16

Context & Objectives Method Results Discussion & Conclusion MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 9/16

Context & Objectives Method Results Discussion & Conclusion Consultation statistics Analysis ‡ Dec. 31 st , 2013 (awstats v0.7) 55,203 visits of the HAS CPG page 10,565 visits of RecosDoc-Diab` ete Mostly (68%) from the HAS website 16000% HAS%web%site%visits% 13272% 14000% RecosDoc%visits% 12000% 10000% 8000% 6794% 5717% 6000% 4850% 4592% 4475% 4065% 4111% 3507% 3329% 4000% 2987% 2354% 1494% 2000% 709% 664% 548% 463% 370% 298% 419% 420% 330% 0% Feb.% March% April% May% June% July% Aug.% Sept.% Oct.% Nov.% Dec.% MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 10/16

Context & Objectives Method Results Discussion & Conclusion Consultation statistics Analysis ‡ Dec. 31 st , 2013 (awstats v0.7) 55,203 visits of the HAS CPG page 10,565 visits of RecosDoc-Diab` ete Mostly (68%) from the HAS website 16000% HAS%web%site%visits% 13272% 14000% RecosDoc%visits% 12000% 10000% 8000% 6794% 5717% 6000% 4850% 4592% 4475% 4065% 4111% 3507% 3329% 4000% 2987% 2354% 1494% 2000% 709% 664% 548% 463% 370% 298% 419% 420% 330% 0% Feb.% March% April% May% June% July% Aug.% Sept.% Oct.% Nov.% Dec.% [Update] ‡ July 31 st , 2014 +1,935 RecosDoc-Diab` etes visits – ≈ 276/month, decreasing MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 10/16

Context & Objectives Method Results Discussion & Conclusion Online questionnaire – Respondent profiles 186 responses 67 free comments Diabe<c$ Professions)(n=184)) Years&of&prac+ce&(n=179)& Type%of%prac+ce%(n=178)% pa<ent$ 2%$ Other$ Coordinated) Other) Healthcare) 5%$ <"5"y" care) 15%) facili,es) Other$HC$ structures) 21%) 21%" prof.$ 3%) 12%$ Other$ >"20"y" Health) specialist$ 48%" centers) 11%$ 5(10"y" 5%) 13%" GPs$ 64%$ Individual) Diabetologis Group) prac,ce) ts$ 10(20"y" prac,ce) 30%) 6%$ 18%" 26%) MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 11/16

Context & Objectives Method Results Discussion & Conclusion Online questionnaire – Answers Physician subgroup analysis (n=147) Study of answers wrt: Profession (GP vs specialist) Years of practice ( < 10 vs > 10) No significant statistical association MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 12/16

Context & Objectives Method Results Discussion & Conclusion Online questionnaire – free comments 67 free text comments (36% of respondents) 10 non interpretable 3 reporting technical problems 54 interpretable MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 13/16

Context & Objectives Method Results Discussion & Conclusion Online questionnaire – free comments 67 free text comments (36% of respondents) 10 non interpretable 3 reporting technical problems 54 interpretable Comment categorization 17 about CPG content (mostly criticisms) 37 about RecosDoc-Diab` ete 25 positive – 16 suggestions for development 12 negative “The decision tree is too complex” “Medicine is an art and cannot be computerized” MIE 2014, Sept. 1st, Istanbul, Turkey S´ eroussi et al. 13/16