Page 15 - Shared Guideline Development Experiences in Fertility Care

group that heavily uses the Internet, which can provide a considerable degree of 1 anonymity in their individual search for information and support [26].
Clinical practise guidelines
A highly valuable tool for improving the quality of fertility care could be created by clinical practice guidelines (CPGs). CPGs are de ned as “statements that include recommendations intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the bene ts and harms of alternative care options” [27]. e development process of CPGs enhances a stepwise process, which starts rstly with clarifying the target audience and selecting or prioritizing the topic of the guideline [28]. Secondly, a deliberate scoping procedure should be performed and preferably guided by a bottleneck analysis, which aims to de ne the objectives and boundary conditions of the guideline as well as to identify potential implementation barriers [28, 29]. Preferably a multidisciplinary CPG development group should be constituted and include all relevant stakeholders [28, 30]. irdly, according to the scope of the guideline, key questions are formulated, prioritized, and answered by systematically reviewing and assessing the relevant literature [30]. Fourthly, recommendations are formulated, which should include considerations of applicability in practice, patients’ preferences, and cost-e ectiveness [30]. Fi hly, an implementation strategy should be conceptualized and written down in the guideline. is strategy could include the development of derivative products, such as a patient version of the CPG, and address barriers for implementation in a separate section of the guideline. e sixth step includes an internal and external review procedure followed by the authorization of the nal guideline. Lastly, the guideline should be disseminated and e orts to implement the guideline should be made, preferably followed by an evaluation that includes monitoring the quality of care by applying guideline-based quality indicators [31].
Application of the guideline and the development of quality indicators
To gain insight into the actual application of the guidelines and as one of the e orts to implement the guideline, the development of guideline-based quality indicators could be seen as a related product of the guideline development process. A quality indicator can be de ned as: “a measurable element of practice performance for which there is evidence or consensus that can be used to assess the quality of care provided, and hence change the quality of care provided” [32]. In general, three types of quality indicators can be distinguished, which refer
Introduction
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