presentazione standard di powerpoint · jama. 1992 jul 8;268(2):240-8. a comparison of results of...
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P Iannone 10122019
JAMA 1992 Jul 8268(2)240-8 A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts Treatments for myocardial infarction Antman EM1 Lau J Kupelnick B Mosteller F Chalmers TC
2017 24586 RCT on PubMed
Institute of Medicine 2011
scelta Guidelines not tramlines
Quality of evidence (Strength of)
recommendation
consensus
Consensus based
Graded recommendations
Certainty
(Level of evidence) Strength
of recommendations
strong
weak low
high
Sometimes trials are unethical or impossible yet
some treatments are quite effective
VALUTAZIONE EtD
Prioritagrave del problema
Effetti desiderati
Effetti indesiderati
Certezza delle prove
Valori
Bilancio dellrsquoeffetto
Costo-efficacia
Certezza delle risorse
Risorse richieste
Equitagrave
Accettabilitagrave
Fattibilitagrave
Patient oriented
Coverage decisions
Public health policy
Screening
Population oriented
LG differenziate per scopi
Il metodo GRADE-ADOLOPMENT
Per adattamento LG
Tradotto da Schuumlnemann et al Journal of Clinical Epidemiology 2017 81 101-110DOI (101016jjclinepi201609009)
Essenziale per la prospettiva nazionale SSN
producing a guideline is a
very complex process involving technical skills (searching
for primary evidence efficiently) value judgements
(rating that evidence) and social aspects (managing
discussion
and achieving consensus within the guideline panel group)
Burgers JS Bailey JV Klazinga NS et al Inside guidelines
comparative analysis of recommendations and evidence in diabetes
guidelines from 13 countries Diabetes Care 2002251933ndash9
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
JAMA 1992 Jul 8268(2)240-8 A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts Treatments for myocardial infarction Antman EM1 Lau J Kupelnick B Mosteller F Chalmers TC
2017 24586 RCT on PubMed
Institute of Medicine 2011
scelta Guidelines not tramlines
Quality of evidence (Strength of)
recommendation
consensus
Consensus based
Graded recommendations
Certainty
(Level of evidence) Strength
of recommendations
strong
weak low
high
Sometimes trials are unethical or impossible yet
some treatments are quite effective
VALUTAZIONE EtD
Prioritagrave del problema
Effetti desiderati
Effetti indesiderati
Certezza delle prove
Valori
Bilancio dellrsquoeffetto
Costo-efficacia
Certezza delle risorse
Risorse richieste
Equitagrave
Accettabilitagrave
Fattibilitagrave
Patient oriented
Coverage decisions
Public health policy
Screening
Population oriented
LG differenziate per scopi
Il metodo GRADE-ADOLOPMENT
Per adattamento LG
Tradotto da Schuumlnemann et al Journal of Clinical Epidemiology 2017 81 101-110DOI (101016jjclinepi201609009)
Essenziale per la prospettiva nazionale SSN
producing a guideline is a
very complex process involving technical skills (searching
for primary evidence efficiently) value judgements
(rating that evidence) and social aspects (managing
discussion
and achieving consensus within the guideline panel group)
Burgers JS Bailey JV Klazinga NS et al Inside guidelines
comparative analysis of recommendations and evidence in diabetes
guidelines from 13 countries Diabetes Care 2002251933ndash9
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
2017 24586 RCT on PubMed
Institute of Medicine 2011
scelta Guidelines not tramlines
Quality of evidence (Strength of)
recommendation
consensus
Consensus based
Graded recommendations
Certainty
(Level of evidence) Strength
of recommendations
strong
weak low
high
Sometimes trials are unethical or impossible yet
some treatments are quite effective
VALUTAZIONE EtD
Prioritagrave del problema
Effetti desiderati
Effetti indesiderati
Certezza delle prove
Valori
Bilancio dellrsquoeffetto
Costo-efficacia
Certezza delle risorse
Risorse richieste
Equitagrave
Accettabilitagrave
Fattibilitagrave
Patient oriented
Coverage decisions
Public health policy
Screening
Population oriented
LG differenziate per scopi
Il metodo GRADE-ADOLOPMENT
Per adattamento LG
Tradotto da Schuumlnemann et al Journal of Clinical Epidemiology 2017 81 101-110DOI (101016jjclinepi201609009)
Essenziale per la prospettiva nazionale SSN
producing a guideline is a
very complex process involving technical skills (searching
for primary evidence efficiently) value judgements
(rating that evidence) and social aspects (managing
discussion
and achieving consensus within the guideline panel group)
Burgers JS Bailey JV Klazinga NS et al Inside guidelines
comparative analysis of recommendations and evidence in diabetes
guidelines from 13 countries Diabetes Care 2002251933ndash9
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Institute of Medicine 2011
scelta Guidelines not tramlines
Quality of evidence (Strength of)
recommendation
consensus
Consensus based
Graded recommendations
Certainty
(Level of evidence) Strength
of recommendations
strong
weak low
high
Sometimes trials are unethical or impossible yet
some treatments are quite effective
VALUTAZIONE EtD
Prioritagrave del problema
Effetti desiderati
Effetti indesiderati
Certezza delle prove
Valori
Bilancio dellrsquoeffetto
Costo-efficacia
Certezza delle risorse
Risorse richieste
Equitagrave
Accettabilitagrave
Fattibilitagrave
Patient oriented
Coverage decisions
Public health policy
Screening
Population oriented
LG differenziate per scopi
Il metodo GRADE-ADOLOPMENT
Per adattamento LG
Tradotto da Schuumlnemann et al Journal of Clinical Epidemiology 2017 81 101-110DOI (101016jjclinepi201609009)
Essenziale per la prospettiva nazionale SSN
producing a guideline is a
very complex process involving technical skills (searching
for primary evidence efficiently) value judgements
(rating that evidence) and social aspects (managing
discussion
and achieving consensus within the guideline panel group)
Burgers JS Bailey JV Klazinga NS et al Inside guidelines
comparative analysis of recommendations and evidence in diabetes
guidelines from 13 countries Diabetes Care 2002251933ndash9
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Quality of evidence (Strength of)
recommendation
consensus
Consensus based
Graded recommendations
Certainty
(Level of evidence) Strength
of recommendations
strong
weak low
high
Sometimes trials are unethical or impossible yet
some treatments are quite effective
VALUTAZIONE EtD
Prioritagrave del problema
Effetti desiderati
Effetti indesiderati
Certezza delle prove
Valori
Bilancio dellrsquoeffetto
Costo-efficacia
Certezza delle risorse
Risorse richieste
Equitagrave
Accettabilitagrave
Fattibilitagrave
Patient oriented
Coverage decisions
Public health policy
Screening
Population oriented
LG differenziate per scopi
Il metodo GRADE-ADOLOPMENT
Per adattamento LG
Tradotto da Schuumlnemann et al Journal of Clinical Epidemiology 2017 81 101-110DOI (101016jjclinepi201609009)
Essenziale per la prospettiva nazionale SSN
producing a guideline is a
very complex process involving technical skills (searching
for primary evidence efficiently) value judgements
(rating that evidence) and social aspects (managing
discussion
and achieving consensus within the guideline panel group)
Burgers JS Bailey JV Klazinga NS et al Inside guidelines
comparative analysis of recommendations and evidence in diabetes
guidelines from 13 countries Diabetes Care 2002251933ndash9
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Graded recommendations
Certainty
(Level of evidence) Strength
of recommendations
strong
weak low
high
Sometimes trials are unethical or impossible yet
some treatments are quite effective
VALUTAZIONE EtD
Prioritagrave del problema
Effetti desiderati
Effetti indesiderati
Certezza delle prove
Valori
Bilancio dellrsquoeffetto
Costo-efficacia
Certezza delle risorse
Risorse richieste
Equitagrave
Accettabilitagrave
Fattibilitagrave
Patient oriented
Coverage decisions
Public health policy
Screening
Population oriented
LG differenziate per scopi
Il metodo GRADE-ADOLOPMENT
Per adattamento LG
Tradotto da Schuumlnemann et al Journal of Clinical Epidemiology 2017 81 101-110DOI (101016jjclinepi201609009)
Essenziale per la prospettiva nazionale SSN
producing a guideline is a
very complex process involving technical skills (searching
for primary evidence efficiently) value judgements
(rating that evidence) and social aspects (managing
discussion
and achieving consensus within the guideline panel group)
Burgers JS Bailey JV Klazinga NS et al Inside guidelines
comparative analysis of recommendations and evidence in diabetes
guidelines from 13 countries Diabetes Care 2002251933ndash9
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Sometimes trials are unethical or impossible yet
some treatments are quite effective
VALUTAZIONE EtD
Prioritagrave del problema
Effetti desiderati
Effetti indesiderati
Certezza delle prove
Valori
Bilancio dellrsquoeffetto
Costo-efficacia
Certezza delle risorse
Risorse richieste
Equitagrave
Accettabilitagrave
Fattibilitagrave
Patient oriented
Coverage decisions
Public health policy
Screening
Population oriented
LG differenziate per scopi
Il metodo GRADE-ADOLOPMENT
Per adattamento LG
Tradotto da Schuumlnemann et al Journal of Clinical Epidemiology 2017 81 101-110DOI (101016jjclinepi201609009)
Essenziale per la prospettiva nazionale SSN
producing a guideline is a
very complex process involving technical skills (searching
for primary evidence efficiently) value judgements
(rating that evidence) and social aspects (managing
discussion
and achieving consensus within the guideline panel group)
Burgers JS Bailey JV Klazinga NS et al Inside guidelines
comparative analysis of recommendations and evidence in diabetes
guidelines from 13 countries Diabetes Care 2002251933ndash9
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
VALUTAZIONE EtD
Prioritagrave del problema
Effetti desiderati
Effetti indesiderati
Certezza delle prove
Valori
Bilancio dellrsquoeffetto
Costo-efficacia
Certezza delle risorse
Risorse richieste
Equitagrave
Accettabilitagrave
Fattibilitagrave
Patient oriented
Coverage decisions
Public health policy
Screening
Population oriented
LG differenziate per scopi
Il metodo GRADE-ADOLOPMENT
Per adattamento LG
Tradotto da Schuumlnemann et al Journal of Clinical Epidemiology 2017 81 101-110DOI (101016jjclinepi201609009)
Essenziale per la prospettiva nazionale SSN
producing a guideline is a
very complex process involving technical skills (searching
for primary evidence efficiently) value judgements
(rating that evidence) and social aspects (managing
discussion
and achieving consensus within the guideline panel group)
Burgers JS Bailey JV Klazinga NS et al Inside guidelines
comparative analysis of recommendations and evidence in diabetes
guidelines from 13 countries Diabetes Care 2002251933ndash9
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Patient oriented
Coverage decisions
Public health policy
Screening
Population oriented
LG differenziate per scopi
Il metodo GRADE-ADOLOPMENT
Per adattamento LG
Tradotto da Schuumlnemann et al Journal of Clinical Epidemiology 2017 81 101-110DOI (101016jjclinepi201609009)
Essenziale per la prospettiva nazionale SSN
producing a guideline is a
very complex process involving technical skills (searching
for primary evidence efficiently) value judgements
(rating that evidence) and social aspects (managing
discussion
and achieving consensus within the guideline panel group)
Burgers JS Bailey JV Klazinga NS et al Inside guidelines
comparative analysis of recommendations and evidence in diabetes
guidelines from 13 countries Diabetes Care 2002251933ndash9
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Il metodo GRADE-ADOLOPMENT
Per adattamento LG
Tradotto da Schuumlnemann et al Journal of Clinical Epidemiology 2017 81 101-110DOI (101016jjclinepi201609009)
Essenziale per la prospettiva nazionale SSN
producing a guideline is a
very complex process involving technical skills (searching
for primary evidence efficiently) value judgements
(rating that evidence) and social aspects (managing
discussion
and achieving consensus within the guideline panel group)
Burgers JS Bailey JV Klazinga NS et al Inside guidelines
comparative analysis of recommendations and evidence in diabetes
guidelines from 13 countries Diabetes Care 2002251933ndash9
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
producing a guideline is a
very complex process involving technical skills (searching
for primary evidence efficiently) value judgements
(rating that evidence) and social aspects (managing
discussion
and achieving consensus within the guideline panel group)
Burgers JS Bailey JV Klazinga NS et al Inside guidelines
comparative analysis of recommendations and evidence in diabetes
guidelines from 13 countries Diabetes Care 2002251933ndash9
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Il ruolo e lattivitagrave del Centro Nazionale Eccellenza Clinica Qualitagrave e Sicurezza
delle Cure in relazione al Sistema Nazionale Linee Guida
Milano 26 giugno 2019
Primiano Iannone
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
multimorbiditagrave
BMJ 2015350h949
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Allineamento ISS allo standard di riferimento internazionale per LG WHO NICE SIGNhellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Offrire LG di alta qualitagrave metodologica rilevanti e valide per le finalitagrave dellrsquo SSN
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Clinical pathway Schedules of medical and nursing procedures including diagnostic
tests medications and consultations designed to effect an efficient coordinated program of treatment (From Mosbys Medical Nursing
and Allied Health Dictionary 4th ed)
Year introduced 1996
Clinical practice guideline
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
bull Pianificazione strutturata e multidisciplinare di un percorso clinico (-assistenziale) bull Finalizzato a trasferire linee guida o evidenze in organizzazioni sanitarie locali
(specifiche) bull Dettaglia i passaggi in un piano algoritmo percorso protocollo o altro inventario di
azioni da compiere in un arco di tempo o sulla base di specifici criteri di progressione bull Inteso a standardizzare lrsquoassistenza per una popolazione specifica
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Clinical practice
Consensus guidelines position statements
Evidence based clinical practice
Evidence based guidelines
Care pathways
Protocols
Quasi laws
Laws
Degree of
freedom
Adozione
violazione
LG come safe harbour
80 circa raccomandazioni deboli quale valore medicolegale
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Piugrave ricerca
Piugrave sintesi di evidenze (LG) adattamento o ex novo
Piugrave delivery of evidence (care pathways)
Piugrave outcome assessments topic
ricerca
guidelines
evidence delivery
(PDTA)
outcome
assessments
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Do we need more research or more translation of research findings
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
Haynes RB et al BMJ 20023241350
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip
guidelines (should) force us to scrutiny
primary research literature in ways that
we donrsquot normally do
Richard Horton Editor of The Lancet
And so what role for clinical guidelines
Advocacy standard of care balanced synthesis of best evidence available identifying research amp healthcare gaps hellip