| AGENCY
RESPONSIBLE |
| 1.
Name | ______________________________________________________ |
| 2.
Country | ______________________________________________________ |
| 3.
Website | ______________________________________________________ |
| 4.
Type of Organisation | p
Academic Institution
p
Medical Speciality Society
p
Disease Specific Society
p
Internationa Agency
p
Managed Care Organization
p
Manufacturer
p
National Government Agency
p
Private Organization
p
Professional Association
p
Regional/Local Government Agency
p
Other, please specify........................................ |
| 5.
Funding | a.
Year of first guideline
................................................................... b.
Reason for guideline development
...................................................................
................................................................... |
6.
Funding
(More than one answer possible) |
p
Own budget
p
Governmental support
p
Pharmaceutical support
p
Other, please specify............................................... |
7.
Estimated budget for guideline development
(Average budget in US dollars
per guideline) |
p
0 - 5000
p
5000 - 10000
p
10000 - 25000
p
25000 - 50000
p
50000 - 100000
p
100000 - 200000
p
> 200000 |
|
8 Estimated budget for
dissemination
(average budget in US dollars per guideline)
|
p
0 - 5000
p
5000 - 10000
p
10000 - 25000
p
25000 - 50000
p
50000 - 100000
p
100000 - 200000
p
> 200000 |
| SCOPE
AND PURPOSE |
9
Objectives
(more than one answer possible) | p
Appropiate clinical care
p
Cost containment
p
Both
p
Other, please specify ............................................................................
|
10.
Level of care
(more than one answer possible) | p
Public Health
p
Primary Care
p
Secondary Care
p
Tertiary Care
|
11.
Target users
(more than one answer possible) | p
Physicians
p
Paramedical professions
p
Nurses
p
Patients
p
Health Care Organisations / Hospitals
p
Policymakers
|
12.
Scope of guidelines
(more than one answer possible) | p
Screening
p
Prevention
p
Diagnosis
p
Treatment / management
|
| 13. Who
selects topics? | ...........................................................................................
...........................................................................................
|
| GUIDELINE
DEVELOPMENT GROUP |
| 14.
Average number of members in a guideline development group | p
0 - 5
p
5 - 10
p
10 - 15
p
15 - 20
p
>20
|
| 15. Average
number of disciplines in a guideline development group | p
0 - 3 disciplines
p
3 - 5 disciplines
p
5 disciplines
|
16. Experts
involved in guideline development
(more then one answer possible) |
| Always
involved | Only
if necessary | | Informatics,
library sciences | p |
p |
| Clinical
epidemiology | p |
p |
| Statistics |
p |
p |
| Communication |
p |
p |
| Health
economics | p |
p |
| Social
sciences | p |
p |
Other,
please specify
............................................ |
p |
p |
|
17.
Involvement of patients
(more than one answer possible) | p
Yes, by participation in development group
p
Yes, by surveys of patients views / preferences
p
Yes, by review by representatives of patients organizations
p
No
|
18.
Who is responsible for editing the guideline?
(more than one answer
possible) | p
All members of guideline devlopment group
p
Chairman and / or secretary of the guideline development group
p
Standing editorial staff
p
Editorial commitee that varies for different guidelines
p
Other, please specify
.......................................................................................
|
| METHODOLOGY
OF GUIDELINE DEVELOPMENT |
| 19.
Is there methodological training for members of the guideline development group
before starting with the guideline development? | p
Yes, obligatory
p
Yes, optional
p
No |
20.
Method used to colect evidence
(more than one answer possible)
| p
Hand searches of published literature (primary and/or secondary sources)
p
Searches of electronic databases
p
Searches of patient registry data
p
Searches on unpublished data
|
21. Methods
used to analyse evidence
(more than one answer possible) | p
Decision analysis
p
Meta-analysis
p
Systematic review
p
Non-systematic review
p
Experience based
|
22. Methods
used to formulate recommendations
(more than one answer possible)
| p
Subjective review
p
Informal expert consensus
p
Formal expert consensus (consensus conferences, nominal group technique or Delphi
technique)
p
Evidence-linked (weighting according to a rating scheme)
|
23. Method
of review
(more than one answer possible) | p
Clinical validation - pilot testing
p
Clinical validation - trial implementation period
p
Comparison with guidelines from other groups
p
External peer review
p
Internal peer review
|
| 24.
Is there a process of guideline authorization? | p
Yes, formal authorization by endorsement by professional organization of the target
users
p
Yes, authorization otherwise, please specify
.......................................................................................
p
No |
| PRODUCT
AND DELIVERIES |
| 25.
Total number of guidelines produced | p
0 - 10
p
10 - 20
p
20 - 30
p
30 - 50
p
> 50
|
| 26.
Average size of guideline | p
0 - 2 pages
p
2 - 5 pages
p
5 - 10 pages
p
10 - 15 pages
p
15 - 25 pages
p
25 - 50 pages
p
> 50 pages
|
27.
Different versions
(more than one answer possible) | p
Extensive version with notes / references
p
Short version
p
One or two page summary
p
Patient version
|
28.
Tool for application
(more than one answer possible) | p
No tools
p
Algorithms / flow charts
p
Balance sheets
p
Risk tables
p
Patient leaflets
|
29.
Media used
(more than one answer possible) | p
Paper
p
CD-ROM
p
Internet |
|
IMPLEMENTATION
STRATEGIES |
30.
Health professional orientated interventions
(more than one answer
possible) | p
Educational materials
p
Conferences
p
Local opinion leaders
p
Outreach visits
p
Patient mediated interventions
p
Audit and feedback
p
(computer) reminders
|
| 31. Use
of financial incentives | p
Yes, specify ................................................................
p
No |
32
Organisational interventions
(more than one answer is possible)
| p
Changes in settings / site of service delivery
p
Changes in physical structure, facilities and equipment
p
Changes in medical records systems
p
Changes in scope and nature of benefits and services
p
Presence and organisation od quality monitoring mechanisms
p
Ownership, accreditation and affiliation status
p
Staff organization
p
Other, specify ...............................................................
.........................................................................................
|
| EVALUATION
AND UPDATE PROCEDURE |
| 33.
Use of monitoring and documentation (systematic data collection) | p
Yes
p
No |
34.
Is there any regular quality system for your guideline program?
(more
than one answer possible) | p
Yes, by developing and publishing criteria for good guideline development ('guidelines
for guidelines')
p
Yes, by revising guidelines based on comments from the professional community
p
Yes, by appraising existing guidelines
p
Yes, we submit the guidelines to a guideline clearinghouse
p
Yes, otherwise please specify
............................................................................................
p
No |
35.
Procedure for updating guidelines
(more than one answer is possible) | p
Updated on regular basis
p
Updated irregularly
p
Formal method, please specify
...........................................................................................
p
No formal method
p
Not updated |
| 36.
What are the plans for further development of your guideline program for the near
future |
...........................................................................................
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