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Kaiser permanente journal

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All articles undergo rigorous peer review by multiple qualified referees, are made available immediately, and are open access. No fees are charged for accepted manuscripts. Email: Honeypot Leave this field empty if you're human:. The Permanente Journal. It is particularly focused on health care delivery and patient-centered medicine, including the understanding and studying of: Integrated health delivery systems Health care modeling and innovations Value-based and high-value care Applied research in health disparities Equity, inclusion, and diversity in medicine.

Exceptional Care Experience. All rights reserved. Each year, the NGP evaluates and selects priority topics to be included in its guideline portfolio. Clinical questions to be addressed are prioritized on the basis of an assessment of several internal and external factors. These factors may include:. Each of the eight KP Regions has the opportunity to present topics of interest, which are then reviewed and voted on by the National Guideline Directors, taking into consideration the criteria above.

If any KP primary or specialty care group presents topics that are not selected for inclusion in NGP priorities eg, the topic doesn't meet prioritization criteria or resource availability , the group has the option to pursue the development of other practice support tools independent of the NGP.

Once a topic has been identified, a GDT is assembled; this team helps specify the scope of the guideline, including target populations, comparative interventions, important outcomes, and other clinical issues. This process provides direction for framing specific clinical questions, which commonly address issues of risk, diagnosis, prognosis, therapy, and harm.

Traditionally, KP's CPGs have been created in-house; that is, the GDT maintained control of the entire guideline development process—from defining the clinical question through conducting systematic reviews, evaluating the evidence, and creating clinical recommendations within the framework of a clinical guideline—regardless of other preexisting external evidence reviews or guidelines. Using these frameworks, the NGP is able to evaluate the quality and applicability of preexisting external guidelines.

For example, if KP were interested in creating a guideline related to human immunodeficiency virus HIV prevention and screening, the GDT might investigate whether any high-quality relevant guidelines or systematic reviews had previously been created or conducted by groups such as the Centers for Disease Control and Prevention, the US Preventive Services Task Force, the Cochrane Collaboration, etc.

If such guidelines are found, the guideline team uses the ADAPTE process to assess congruence with identified clinical questions, analyze guidelines for quality, and make adaptations as needed to fit KP's context and needs Table 2. AGREE domains of guideline quality and usability 9. If no acceptable external guidelines are identified, the GDT then systematically searches for relevant high-quality systematic reviews, meta-analyses, and original studies.

Existing systematic reviews are assessed for quality using a measurement tool to assess systematic reviews the AMSTAR systematic review checklist , 13 another tool new to KP's methodology Table 4. If systematic reviews are identified and deemed high quality by the AM-STAR checklist, the GDT may opt to use a preexisting review, rather than complete a systematic review de novo.

In these cases, evidence analysts perform a supplementary search to identify any new studies that may have been published following the date of the preexisting review. If no existing guidelines or systematic reviews are identified, the team conducts a full formal systematic review of the literature. This process includes the creation of a search strategy, database and hand searches for relevant studies, and evaluation of studies for relevance to the clinical question and the area of inquiry eg, screening, diagnosis, prognosis, testing, treatment, or harms.

Meta-analysis, or the statistical synthesis of results from independent studies, is often, though not always, employed. By combining the results from all relevant studies, this approach allows guideline developers to understand the combined weight and quality of the evidence, including direction and strength of association, and possible underlying heterogeneity or differences in the estimates of effects between studies.

This approach is widely used internationally, and provides a systematic, transparent, and explicit framework to grade the quality of bodies of evidence. The higher the quality of the available evidence, the more confident one can be that an estimate of effect or association is close to the actual outcome of interest. Formulating recommendations based on quality of evidence, balance of benefits and harms, patient values and preferences, and resource and cost implications.

The quality of evidence for each important outcome includes consideration of six elements: study design, study quality, consistency, directness, precision, and possible reporting bias. The GRADE system classifies the quality of evidence into the following four levels with corresponding implications:.

High quality—further research is very unlikely to change confidence in the estimate of effect. Moderate quality—further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate. Low quality—further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate. Very low quality—any estimate of effect is very uncertain Table 5. GRADE levels of evidence across outcomes When based on randomized control trials, the body of evidence is initially categorized as high quality.

However, the evidence grade may be reduced for reasons including study limitations, inconsistency of results, indirectness, imprecision, and publication bias. When based on observational studies eg, cohort or case-control studies , the body of evidence is initially categorized as low quality. However, the evidence grade may be increased if, for example, the magnitude of treatment effect is very large or if there is evidence of a dose-response relationship.

GRADE focuses on four key factors that must be considered when assigning strength to a recommendation: balance between desirable and undesirable effects, quality of evidence, values and preferences, and cost Table 6. Determinants of strength of recommendations The final outcome of this process is the creation of evidence-based clinical recommendations that address the clinical questions posed at the outset of the process.

A recommendation may contain one or more parts. Rationale statements—explicitly addressing the four GRADE strength of recommendation domains—are written to explain the logic that links the evidence synthesis and GRADE analysis to the appropriate recommendation Table 7.

Following the completion of a CPG, next steps in KP's process include dissemination and implementation activities. From the Clinical Library, physicians and health care professionals throughout KP can then access the guidelines. Ideally, the goal of guideline implementation is to enhance the likelihood of successful changes in practice, specifically the increased application of evidence-based practices.

This allows KP to provide point-of-care support and guidance for clinicians. Guidelines are embedded in the process of care delivery through KP HealthConnect standard orders, alerts and clinical tools, program protocols, clinician reminders, member education and outreach, and other tools.

Generally, these tools are developed by each Region to meet local needs. A variety of additional decision support tools and summary documents, including guideline change documents, diagnosis-specific quick reference guides, clinician and staff educational materials, and patient education materials may be developed to support recommendations.

Guideline change documents outline any changes as compared with previous versions of a CPG. KP has the capacity to monitor and evaluate clinician adherence to clinical guidelines as well as to monitor effects on health care outcomes.

KP's CPGs are intended not only to enhance patient and clinical decision making but to improve health care outcomes and quality of care, to meet state and federal regulatory requirements, and to support voluntary organization accreditation and internal quality improvement and patient safety initiatives. Through the use of KP patient data, clinical care gaps can be identified, performance and quality goals developed, and specific initiatives implemented through clinical guideline recommendations that address best practices.

If you are a user or developer of guidelines, a consumer or clinician, or are an administrator or operations specialist, transparency regarding CPGs and how they are developed should matter to you.

The recently published IOM standards 1 are intended to reduce variability and to standardize the level of rigor and quality that goes into developing CPGs and in performing systematic reviews of the evidence. KP's new methodology meets the majority of these standards.

In reviewing KP's CPG methodology, it is apparent that the NGP is well-aligned with the following IOM standards: establishing transparency, management of conflict of interest, multidisciplinary and balanced guideline development group composition, effective management of the CPG and systematic review intersection, assessing evidence foundations and assigning strength of recommendations, and articulation and updating of recommendations. Because the NGP has been developed primarily to create CPGs for use within its integrated delivery system, KP has not previously pursued patient and consumer involvement in guideline development and review.

However, the National Guideline Directors are currently exploring options for meeting these standards and standards related to the development and public posting of systematic reviews.

This article demonstrates that the goals of KP's NGP are reflected in the new methodology as well as in the CPGs that are produced at the national level. This new and rigorous methodology provides the framework for developing CPGs that end users can trust in their medical care decisions. Although challenging, the new IOM standards present guideline developers and clinicians with several opportunities.

If other organizations continue to improve the rigor and transparency of their processes, it is likely that sharing high-quality systematic reviews and guidelines will increase. Furthermore, increased collaboration between developers of systematic reviews and CPGs could influence public funding and allocation of resources to address health topics that are the most important to patients, clinicians, and health care delivery systems.

Read article at publisher's site DOI : Crous EC , North N. Curationis , 44 1 :e1-e10, 06 Oct Health Serv Res , 55 Suppl , 23 Oct Free to read.

Health Res Policy Syst , 18 1 , 29 Sep Martin JP , Aboubechara N. Curr Diab Rep , 17 9 , 01 Sep Cited by: 0 articles PMID: Br J Haematol , 6 , 14 Mar Cited by: 13 articles PMID: To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.

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Europe PMC requires Javascript to function effectively. Recent Activity. Search life-sciences literature 41,, articles, preprints and more Search Advanced search. This website requires cookies, and the limited processing of your personal data in order to function.

By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. Davino-Ramaya C 1 ,. Krause LK ,. Robbins CW ,. Harris JS ,. Marguerite Koster Search articles by 'Marguerite Koster'. Koster M ,. Wiley Chan Search articles by 'Wiley Chan'. Chan W ,. Tom GI. Affiliations 1 author 1. Share this article Share with email Share with twitter Share with linkedin Share with facebook. Abstract Introduction The practice-guideline process of collecting, critically appraising, and synthesizing available evidence, then developing expert panel recommendations based on appraised evidence, makes it possible to provide high-quality care for patients.

Methods A multidisciplinary group of stakeholders, with representation from all eight Kaiser Permanente Regions, is responsible for creating National Guidelines. Study appraisal Following the screening and selection process, the included studies the "body of evidence" are critically appraised for quality, using the GRADE methodology, which focuses on four key factors that must be considered when assigning strength to a recommendation: balance between desirable and undesirable effects, quality of evidence, values and preferences, and cost.

Free full text. Perm J. Published online Winter PMID: Author information Copyright and License information Disclaimer. E-mail: gro. This article has been cited by other articles in PMC. Go to:. Institute of Medicine Standards.

Definition of Clinical Practice Guidelines. Evidence based medicine: what it is and what it isn't. Adding value to evidence-based clinical guidelines. Open in a separate window. Figure 1. Through G-I-N, the NGP was exposed to a number of international collaborative groups that had been developing frameworks and tools to improve the guideline development process, including: ADAPTE collaboration: provides a structured framework and systematic approach to adopt or adapt preexisting CPGs as an alternative to de novo guideline development.

Figure 2.

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Implementation for 3 of these medical centers occurred in January through November , with implementation for the remaining 19 medical centers occurring from September through September Lessons learned: Critical factors include adequate dedicated time for PI activities by staff with necessary expertise, expert support to operations, alignment of projects with regional and national strategic priorities, and close working relationships between PI staff and operational management.

Involving finance leaders in improvement planning, prioritization, and oversight is important. These elements can be adapted to smaller systems and single hospitals.

Conclusions: The initial evaluation of the Kaiser Permanente PI system indicated that 1 IAs successfully led projects in conjunction with frontline teams, 2 organizational capabilities increased, and 3 the investment in PI infrastructure and staff was sound.

The journal encourages submissions in clinical medicine, especially discussions of care outcomes in a value-based health care environment. It delivers original research, case reports, reviews, commentaries, editorials, and other articles of interest to interdisciplinary care teams, clinical researchers, educators, and learners.

The Permanente Journal is published online every quarter with the support of The Permanente Federation. All articles undergo rigorous peer review by multiple qualified referees, are made available immediately, and are open access. No fees are charged for accepted manuscripts. Email: Honeypot Leave this field empty if you're human:.

The Permanente Journal.

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Most Asked Kaiser Permanente Interview Questions and Answers

WebPublished since , The Permanente Journal is an independent medical journal, providing a forum for thought leadership, scholarship, and discovery. It is particularly . WebAt Kaiser Permanente, everything works together for one very important cause. You. Your personal care team Our doctors, hospitals, and health plans are all connected — . WebThe Permanente Journal. Pankaj Gupta, MD is an Assistant Professor in the Department of Radiodiagnosis at the Postgraduate Institute of Medical Education and Research in .