Page 16 - Shared Guideline Development Experiences in Fertility Care

Chapter 1
to the process, outcome, and structure of care [33]. Quality indicators should preferably be developed through a systematic approach that ensures transparency [34]. Guideline-based quality indicators are generally based on selected recommendations extracted from guidelines and are comprised of a numerator (the case in which a recommendation is followed) and a denominator (all cases in which the recommendation is applicable). is step is mostly followed by a panel method to select nal quality indicators and a practice test to evaluate its validity, reliability, and feasibility [1]. ese last two steps are very important since judgements of quality of care based on measurements of quality indicators could have far-reaching consequences, such as when pay-to-performance models are in use.
Approaches to guideline development
In the presence of worldwide development of institutional manuals for developing CPGs, the processes described in these manuals are inconsistent and the assessed quality of the delivered guidelines is diverse [36].
Generally, two types of guidelines are currently developed: the monodisciplinary and the multidisciplinary CPG. e monodisciplinary CPG is developed and owned by an individual professional society. In addition to creating a sense of institutional ownership over the developed guideline, this approach has more disadvantages than advantages. Firstly, monodisciplinary guidelines are assessed of lower quality than multidisciplinary guidelines [38]. Furthermore, inconsistencies in recommendations for the same clinical topic in di erent societies’ guidelines may threaten the quality of care. e more recently introduced and recommended multidisciplinary CPG is developed by a collaboration of di erent stakeholders. is approach intends to improve the quality of CPGs and enhance its implementation, enabling broader support and adjustment between professionals.
Although the development of CPGs has progressed enormously worldwide, unwarranted practice variation in daily care remains a problem. ere are multiple reasons for these practice variations, including those on the personal, organisational, and systemic levels. However, by rstly concentrating on the approach used in the guideline development process and its consequences, several de ciencies can be identi ed. Among these, the lack of guideline ownership felt among the target users and the strong focus on clinical aspects rather than on the organisational and other aspects of patient-centredness of care impede full implementation [36-
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