1. Copyright © 2010 by ICSI 1 #2257 Copyright © 2010 by ICSI Transforming Health Care Through Collaboration Institute for Clinical Systems Improvement (ICSI) Guideline Program: Implications of IOM CPG Standards

2. Copyright © 2010 by ICSI 2 #2257 Institute for Clinical Systems Improvement ICSI A collaboration of over 50 medical groups & hospital systems Sponsored by six health plans Established 1993 Includes roughly 60 hospitals and medical practices with about 8300 physicians

3. Copyright © 2010 by ICSI 3 #2257

4. Copyright © 2010 by ICSI 4 #2257 ICSI Scientific Document Program Guidelines - 30 Protocols - 6 Order Sets – 12 Available on the NGC and ICSI website

5. Copyright © 2010 by ICSI 5 #2257 ICSI’s Scientific Documents: Behavioral Health –ADHD –Depression in Primary Care Cardiovascular –Acute Coronary Syndrome –Antithrombotic Therapy –Coronary Artery Disease –Congestive Heart Failure –Hypertension Lipid Mgmt –Stroke –VTE Prophy –VTE DX and TX Musculo-Skeletal –Low Back Pain –Chronic Pain Preventive Health –PPCD –CRC Screening –Immunizations –Obesity Prev & Mgmt –Prev Sx Adults & Children

6. Copyright © 2010 by ICSI 6 #2257 ICSI’s Scientific Documents: Respiratory Disease –Asthma –COPD –Dx & Tx Resp Illness (adults and children) Other Conditions –Diabetes –Headache –Palliative Care –Preoperative Evaluation Women’s Health - Breast Disease - Initial Mgmt of Abnormal Pap and HPV Testing - Mgmt of Labor - Osteoporosis - Prenatal Care

7. Copyright © 2010 by ICSI 7 #2257 Revision Process

8. Copyright © 2010 by ICSI 8 #2257 Revision Process “Wake Up” The Document Schedule Work Group Meetings Member input into the revision Revision Preparation Work Group Meetings Document Review Member Review and Approval Publish Document

9. Copyright © 2010 by ICSI 9 #2257 Components Clinical Flow Annotations Aims and Measures Implementation Recommendations Graded Evidence

10. Copyright © 2010 by ICSI 10 #2257 Crosswalk / Gap Analysis of ICSI Process and IOM Standards Meet Standard Currently working on closing this gap Small gap with a quick fix Large gap – may be able to close May be unable to close this gap

11. Copyright © 2010 by ICSI 11 #2257 Meeting / Will Meet: Establishing transparency Conflict of interest Guideline development group composition CPG – SR intersection (4.1 use of SR) Evidence foundations and strength of recommendations Articulation of recommendations Updating

12. Copyright © 2010 by ICSI 12 #2257 Areas with Significant Gap: CPG – SR intersection (4.2 SR development process) –Time and resource to do new reviews for all elements addressed in our GLs External Review (7.1, 7.4) –Review and posting for comment from outside of GDG but ICSI membership only

13. Copyright © 2010 by ICSI 13 #2257 Opportunities: Development of an endorsement process –maintaining “fair process” Sharing of skills, resources and products between other GL developers – decrease duplication – broader stakeholder perspective & involvement – efficiency

14. Copyright © 2010 by ICSI 14 #2257 Opportunities: Specializing in specific GL components –SRs –Specific conditions –Implementation recommendations –Measures Common evidence grading Increased availability of external SRs

15. Copyright © 2010 by ICSI 15 #2257 Key Challenges Resources (both internally and externally) Trusting documents not developed locally Inconsistent implementation of IOM standards Recommendation statements for integration into patient care delivery Timely update of external CPGs Timely availability & update of SRs

16. Copyright © 2010 by ICSI 16 #2257 Copyright © 2010 by ICSI Transforming Health Care Through Collaboration Questions? Cally Vinz cally.vinz@icsi.org 952-814-7068