What is implementation science ?
Implementation science is a precise branch of medical science that helps medical aid providers recommends tests and evaluation methods to achieve a strong and accurate diagnosis. In medical science, there is nothing more crucial than making accurate decisions regarding the prognosis and diagnosis of health conditions, failing which, the patient can face disastrous repercussions including untimely mortality. Appropriate and efficient health car is therefore based on precision and accuracy.
However, owing to the numerous tests and evaluation procedures available today, it becomes necessary to provide proper guidance to clinicians when it comes to implementing the methods of diagnosis. While tests are advisable for a number of reasons, depending solely on the guidelines prescribed might not be sufficient in reaching the right conclusion. Expertise and experience of the practitioner play a major role in evaluating various procedures and reading the results of the tests accurately.
Moreover, complete reliability on the guidelines may give way to a margin of error since the several fields have to researched and explored for each test. The recommendations provided by practitioners should consider all factors that may have an influence on health. In order to evaluate the efficiency and effectiveness of various factors related to making medical recommendations, a case study was taken up by a group of researchers.
What are the different methods involved ?
In order to evaluate the issues in question, a team of researchers conducted case study that took into consideration records of meetings and by critically analyzing the processes that are used in developing guidelines related to WAO CMA. Three researchers of the team belong to GRADE working group and have made significant contributions to developing the GRADE model.
In order to achieve strong and accurate results from the study, a panel consisting of twenty two members having international experience and expertise were selected for the study. The group of elite panelists consisted of allergists, dermatologists, gastroenterologist, pediatricians, family physicians, epidemiologists, developers of guidelines, food chemists and representatives of organizations of patients. Two methodologists were employed in the study in order to evaluate the evidence and synthesize them. They also helped in developing clinical recommendations. These experts were highly experiences in GRADE approach application.
As per the guidance of World Health Organization, the members in the committee were made to fill up a declaration form declaring conflict of interests. As per this agreement, experts could be excused from the committee and the discussions based on influencing factors. These guidelines are also recommended by the American Thoracic Society.
During the process of developing guidelines related to the study, it was ensured that there was regular interaction among the members of the committee. When members were not present physically, they were involved in the discussions by means of e-mails and video conferences. The minutes of these conferences were recorded carefully and the opinions of all the experts were taken into consideration while drawing final conclusions of the study. In 2009, a direct meeting was held, which included all the members of the panel of experts. Discussions were held and the records were compiled. A follow up session was held following the major discussion in order to clear up loose threads of the study. The recommendations by experts that needed more clarifications were brought up in the follow up study.
In order to make the study completely foolproof and to aid accuracy, the Delphi method was used. In this method, questionnaires were emailed to the experts prior to the meetings and answers were solicited. The answers were based on individual opinions of the experts and were not influenced by the group discussions. Structured discussion was used during the meeting with an aim to understand complex issues related to methodology. These methods also helped substantially in drawing conclusions on recommendations.
Hence, by using a mix of efficient methodology and critical analysis of the results of discussions and recommendations, results were presented on the basis of the Grading of Recommendations Applicability, Development and Evaluation, which is short for GRADE. This approach was used to generate guidelines for clinical practice with regard to the Cow Milk Allergy.
Results of the study
As a result of the study, it was found that the panel members could generate recommendations of the study in a better manner following group processes, which includes different processes such as formulation of questions, providing analysis of outcomes important for patients based on diagnostic tests and finally formatting a summary for all the evidence assimilated. Concepts such as treatment threshold and pre-test probability, which are got out of medicine recommendations based on evidence, help in providing better recommendations that are more implementable. The results are applicable internationally. The experts who were used in the study provided good insight into the manner in which recommendations are made so as to prevent providing wrong diagnosis and causing harm to the patients.
In keeping with the GRADE approach, the study categorized the recommendations on the basis of their strengths of implementations. They were categorized as strong and weak, with weak also being called conditional. On the whole, the study came out with fifteen recommendations regarding the applicability of diagnostic tests.
Discussion of the study
Guideline developers can be hugely benefited from this study since the study provides inroads into generating guidelines that bring out the most accurate diagnosis and recommendation patterns. Clinicians can also be largely benefited by the study since they obtain a clearer idea of what is required to bring about the implementation of recommendations. Doctors can also use the study as a parameter to build up confidence while recommending clinical tests to their patients. GRADE approach has a requirement of transparency that helps in better development, generation and implementation of recommendations of the diagnostic tests. A structured and definite framework such as GRADE model can help in generating evidence and describing influential factors that facilitate outlining the processes involved in treatment.
This study is an effective benchmark for all those medical practitioner interested in using the GRADE approach in their practice. The GRADE approach is already in use by more than fifty organizations.