1. Exploring the Power of “Search” National Guideline Clearinghouse (NGC) and National Quality Measures Clearinghouse (NQMC) Web Sites Melanie Moyer Swan, MPH, PMP Program Manager, NGC/NQMC, ECRI Institute Project Manager, NQMC Lisa T. Haskell, MS, OTR/L Project Manager, NGC, ECRI Institute

2. About the Search Function Search engines are state-of-the-art tools designed for sophisticated retrieval of medical information. Results are ranked to ensure the most relevant matches are at the top of the page. Search expressions are not case-sensitive; simply type in a word or phrase.

3. Searching UMLS Concepts Search engines run in conjunction with a layer of semantic metadata applied to NGC/NQMC content. Medical language tags from selected vocabularies (e.g., MeSH, SNOMED) in the Unified Medical Language System (UMLS) from the National Library of Medicine Run a search on a UMLS concept by clicking on the term inside the Classification tab. Index-only search Full-text results are not included

4. Searching UMLS Concepts

5. User Search Tips Search within browse or search results Options to sort by relevance (default) or date Spelling suggestions are provided when a search term is spelled incorrectly Click a suggested word to search on that term Words found within the body of a document are highlighted when the user navigates to the document from a search results page.

6. Advanced Search Allows the user to select specific subsets of Guideline or Measure summaries Narrows the total data set by using selected filters Resulting number of documents displayed on the page after selection of each filter

7. Advanced Search Keyword is optional Checking at least one box is required. Index-only searches may be run on MeSH terms (as are used on By Topic browse) by selecting the Disease or Condition, Treatment or Intervention and Health Services Administration checkboxes.By Topic browse

8. Advanced Search: NGC http://www.guideline.gov/search/advanced-search.aspx http://www.guideline.gov/search/advanced-search.aspx Narrow search results by using any of these filters: Publication year (1997-2012) Guideline developer Type of organization (academic institution) Age group and sex of target population Clinical specialty (nursing, pediatrics) Guideline category (treatment, screening) Implementation tools (algorithms, patient resources) Intended Users (physicians, hospitals)

9. Advanced Search: NGC http://www.guideline.gov/search/advanced-search.aspx http://www.guideline.gov/search/advanced-search.aspx NGC filters continued. Institute of Medicine (IOM) care need or IOM domain Methods to analyze evidence (meta-analysis) Methods to assess the quality & strength of evidence (rating scheme) Methods to formulate the recommendations Limit to guidelines that include specific elements (implementation plan, cost analysis)

10. Advanced Search: NQMC http://qualitymeasures.ahrq.gov/search/advanced-search.aspx Narrow search results by using any of these filters: Measure domain (Clinical quality measures: Outcome) Measurement setting (Hospitals) Least aggregated level of services delivery addressed (Single Health Care Delivery or Public Health Organizations) Professionals involved in delivery of health services (Physicians) Current use (Pay-for-performance) Data source (Electronic health/medical record)

11. Advanced Search: NQMC http://qualitymeasures.ahrq.gov/search/advanced-search.aspx NQMC filters continued. Organization (AHRQ) Organization type (Federal government agency [U.S.]) Endorser (National Quality Forum) Measure initiative (Hospital Compare) Institute of Medicine (IOM) care need or IOM domain Age range and Gender Publication year (1998-2012) Vulnerable Population (Children)

12. Real World Application: NQMC Searched the literature to identify recent works by researchers who used NQMC for a research source Quality Measures for Primary Care of Complex Pediatric Patients. Chen et al., Pediatrics. 129(3):433- 45; 2012 Mar. Used NQMC to conduct an environmental scan Identify existing measures using specified search term constructs Primary care, patient-centered care, family-centered care, medical home, chronic care model, disease management, care coordination, coordination of care, continuity of care, comprehensive care, chronic conditions, complex conditions, developmental conditions Inform development of new quality measures

13. Real World Application: NQMC Quality improvement in neurology: AAN epilepsy quality measures: Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology. Fountain et al., Neurology; 76(1):94-9; 2011 Jan. Used NQMC and NGC as an element of their evidence- based literature search strategy Identified published guidelines, measures, & consensus papers to inform epilepsy quality measure development process

14. Real World Application: NQMC The PEACE Project: Identification of Quality Measures for Hospice and Palliative Care. Schenck et al., Journal of Palliative Medicine. 13(12): 1451-9; 2010 Dec. Used NQMC as one of their resources to identify: Published quality measures targeting care in each of the 8 National Consensus Project for Palliative Care Quality

15. Real World Application: NQMC Quality Measurement in Diabetes Care. Leas et al., Population Health Management. 12(5): 265-71; 2009. Used NQMC as part of their strategy to perform An environmental scan to identify and categorize existing diabetes measures Quality of Care Measures for Migraine: A Comprehensive Review. Gagne, et al., Disease Management. 10(3): 138-146. 2007 Used NQMC as part of their strategy to identify: Existing quality indicators that can be used to assess the quality of care delivered to migraine sufferers at the health- plan level

16. Real World Application: NQMC

17. Real World Application: NGC Compendium of national guidelines for imaging of the pediatric patient. Williams CH & Frush, DP. Pediatr Radiol. 2012 Jan;42(1):82-94. Objective: To generate a list of national medical organization- endorsed guidelines with provisions for imaging the pediatric patient. Search Strategy: Using NGC’s Advanced Search function, the keywords imaging, imaging guidelines, and radiograph were independently searched with Clinical Specialty limited to Pediatrics. Results: Over 200 guidelines!

18. Real World Application: NGC We can narrow the search results further by looking at the inclusion criteria: Guidelines produced by the following US-based organizations: American College of Radiology, American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons, American Academy of Family Physicians, National Institutes of Health, United States Preventive Services Task Force. Guidelines that contain “…at least some specific recommendations for the use of imaging in children…”

19. Real World Application: NGC Using several checklists narrowed the search results to 47! This could be narrowed even further by the “Search within” feature.

20. Question! After completing this Compendium, how could the authors ensure the guidelines/measures they included are the most current? Answer: The New Personalization Feature!

21. Personalization Features Easy Access to: Recent Searches Recently Viewed Guideline and Measure Summaries Favorite Guideline and Measure Summaries Favorite Organizations Topic Alerts Domain Alerts (NQMC only) Expert Commentary Alerts Or Create Customized E-mail Alerts

22. “My NGC” Personalized Home Page The user is shown a summary of his personalized content, and reminded that he can use the dashboard to manage this content. The user's recent searches are displayed. The user's recently viewed Guideline Summaries are displayed. Personalized “Welcome” message.

23. “My NQMC” Personalized Home Page

24. “My NGC/ NQMC” Sign-in

25. “My NGC” User Dashboard

26. Selecting Topic Alerts for NGC

27. “My NQMC” User Dashboard

28. Selecting Domain Alerts (NQMC only)

29. Saving Favorite Summaries

30. Saving Favorite Organizations: NGC

31. Saving Favorite Organizations: NQMC

32. Customized E-Mail Alerts: NGC Favorite Guideline/Measure Summary Alerts: Sent when your favorite summary or summaries have been updated or withdrawn. Favorite Organization Alerts: Sent when a summary or summaries associated with your favorite organization have been published, updated or withdrawn. Topic Alerts: Sent when a summary or summaries, associated with a topic, have been published, updated, or withdrawn. Expert Commentary Alerts: Sent when a new Expert Commentary is published to the site.

33. Customized E-Mail Alerts: NQMC NQMC allows you to receive all the same alerts as NGC. Plus… Domain Alerts: Sent when a summary or summaries, associated with that domain, have been published, updated, or withdrawn.

34. Thank You for Listening! Questions ?