Our thirteen Working Groups have been set up through the drive and enthusiasm of members, keen to make an impact in a specific area. Some may be short term, with the objective of writing a publication; others, such as GIN Public are long established and continuously seek to make progress in their chosen area. The Working Groups have the opportunity to apply for a GIN grant to help achieve their goals.
If you are a GIN member and are interested in joining a Working Group, please email email@example.com, noting which group/s you would like to join.
Accelerated guideline development is a way to produce clinical practice guidelines or recommendations in a short amount time, six months or less, without losing in scientific quality.
Producing clinical practice guidelines requires substantial time (usually 12 months or more), expertise (not so easy to find) and resources (in constant decrease). First, guidelines producers have struggled to develop high-quality clinical practice guidelines, from the analysis of the literature to the constitution of the working and peer-review groups. The AGREE instrument has been a true help for the guideline’s producers regarding this point – even if the tool is about evaluating; it is also a good reminder for developing best practice guidelines. The ADAPTE manual has assisted in this task. It is an interesting tool which allows the reduction in the duration of the guideline development. The pressure of the public authorities and clinicians for having guidelines developed in a short amount of time, i.e., six months or less, is so strong in a fast-paced society that the community of the guideline’s producers have to find an answer quickly in order to meet demands.
Aims & Objectives
The aim of the Accelerated Guideline Development Working Group was to provide a method for helping the GIN members to develop guidelines in an accelerated time frame, i.e., 6 months or less. This method is now available on the GIN website. The manual can be downloaded on the Resources page. GIN members can test the manual in producing an accelerated guideline and send us back information by completing the testing phase questionnaire.
Chair: Sophie Blanchard
Guideline adaptation is the systematic approach to the endorsement and/or modification of a guideline(s) produced in one cultural and organisational setting for application in a different context. Where high quality guidelines are already available, adaptation may be used as an alternative to de novo guideline development to customise the existing guideline to the needs of local users.
The development and updating of high-quality clinical practice guidelines require substantial time, expertise and resources. Health organisations are increasingly confronted by the need to standardise health policies and practises to better manage finite resources and to promote optimal, evidence-based patient care. There is pressure on organisations to produce guidelines rapidly, to ensure that medical practice is consistent with current, emerging medical knowledge and this work is often done with limited resources. Guideline adaptation recognises and responds to legitimate differences in organisational, regional or local contexts that could lead to variations in recommendations supported by the same evidence. We postulate that existing high quality guidelines as a resource may be an alternative to de novo development to reduce duplication of effort, enhance efficiency, and promote local uptake of quality guideline recommendations.
Following the development and evaluation of the manual and resource toolkit, the ADAPTE Collaboration decided to make these resources available to the international community through GIN. To view the toolkits please visit the Resources section of the Adaptation Working Group pages. The establishment of the GIN Adaptation Working Group supports and facilitates the involvement of GIN members in these activities.
The Adaptation working group aims to:
Chair:Airton Stein Vice Chair:Ein-Soon Shin
About the Accelerated Guideline Development Working Group
Appraising and Including Different Knowledge in Guideline DevelopmentEvidence-based guidelines whether national, regional, or developed by specialty groups, must search for, and explicitly consider, evidence from sources other than conventional clinical trials and their quantitative data. This need for appraising and including knowledge from a wide variety of sources in guideline development is well recognised. However, how to properly appraise (judge) and include (integrate) different kinds of knowledge remains unclear.
Cited from Wieringa S, Dreesens D, Forland F on behalf of the AID Knowledge Working Group of the Guidelines International Network, et al Different knowledge, different styles of reasoning: a challenge for guideline development BMJ Evidence-Based Medicine 2018;23:87-91.
To bring guideline developers together, to
We also aim to support capacity building and to foster collaboration among guideline developers worldwide in this area of methodological uncertainty.
Congratulations to Teun Zuiderent-Jerak, Beth Shaw and others in the AID Knowledge working group on their latest publication: From “getting things right” to “getting things right now”: Developing COVID-19 guidance under time pressure and knowledge uncertainty.
Read it online here: https://onlinelibrary.wiley.com/doi/full/10.1111/jep.13625
Chair:Beth Shaw Vice Chair: Teun Zuiderent-Jerak
GINAHTA’s main objective is to explore common methods and to facilitate collaboration and sharing of products between the HTA (represented by INAHTA) and guideline (represented by GIN) communities.
The worlds of guidelines and health technology assessment (HTA) may be more similar than they appear at first sight. To explore common methods and to facilitate collaboration and sharing of products between the HTA (represented by INAHTA) and guideline community (represented by GIN) a working group was established in October 2015.
INAHTA is a network of 51 HTA agencies that support health system decision making that affects over 1 billion people in 32 countries around the globe. With more than 2,100 staff and consultants working in the INAHTA network, there are clear benefits to connecting these agencies together to cooperate and share information about producing and disseminating HTA reports for evidence-based decision making. INAHTA serves this purpose. www.inahta.org
The working group acts as a facilitator to join efforts of the HTA and guideline community by:
How to Join
GIN or INAHTA members who are interested in joining should write to: firstname.lastname@example.org.
Co-Chair:Holger SchunemannCo-Chair: Mouna Jameleddine
About GIN PUBLIC
The main objective of GIN PUBLIC is to support effective patient and public involvement in the development and implementation of guidelines. GIN PUBLIC offers a forum for exchange between patient and public organisations, guideline developers, and researchers.Who we are
GIN PUBLIC is a working group of researchers, health professionals and consumers who promote ways to inform and involve the public in guideline activity around the world.
The current Chair of the GIN PUBLIC Working Group is Jane Cowl
Aims and objectives
The main objective of the GIN PUBLIC Working Group is to promote ways to inform and involve the public in guideline activity around the world. GIN PUBLIC offers a forum of exchange between patient and public organisations, guideline developers, researchers, and others with an interest in patient and public involvement. This is mainly done through our discussion forum, working group meetings, and by holding workshops and presentations at conferences such as the GIN annual meeting.
Specific aims are to:
GIN PUBLIC Toolkit: Patient and Public Involvement in Guidelines
For the full toolkit and all updates, please visit the GIN Public Toolkit section on our resources page
Chair: Jane Cowl Vice Chair: Karen Graham
GIN Tech are members that are also software developers or members that are interested in technology development. We are currently made up of member-organisations that are also software developers, (both commercial and non-profit), members of in-house digital teams from different guideline producing organisations (e.g., NICE, Duodecim, Joanna Briggs Institute) or members that are just interested in tech development. The software developers and digital teams cover all aspects of guideline development, from evidence detection to publishing guidelines and production of point of care decision support. See here for GIN Tech working group members.
The core aim of the working group is to aid GIN members in sharing data from the various digital tools and providing a forum for members to discuss the best way to use the tools that are available. As part of this we aim to understand the needs of guideline producers, the issues you face and the opportunities for improvement that digital solutions may offer.
Chair:Ton Kuijpers Vice Chair: Linn Brandt
Our mission is to identify and facilitate strategies for successful collaborations among guideline developers in the development of evidence-based recommendations.
GIN GCWC proposes the following activities to support their vision
Chair:Rebecca Morgan Vice Chair: Toju Ogunremi
The primary purpose of the Implementation Working Group (IWG) is to build capacity for guideline implementation. To do so, the IWG will progress the science of guideline implementation by generating knowledge and associated outputs/products on how to plan, undertake, enable, and evaluate guideline implementation. It will also promote the practice of guideline implementation by generating and sharing knowledge and tools and organising and offering training opportunities.
The primary purpose of the Implementation Working Group (IWG) is to build capacity for guideline implementation.
To do so, the IWG will:
Chair:Anna Gagliardi Vice Chair: Sanne Peters
The GIN Low and Middle Income Countries (LMIC) Working Group (WG) was created in 2015, to build a platform wherein issues related to resource-constrained health-care settings could be shared. This is an area of great need, not only in most developing countries, but also in some higher income societies wherein guideline development is at a nascent stage.
Chair: Joseph Mathew
The GIN Board of Trustees agreed to establish the Multimorbidity Working Group after considerable interest was shown in the topic at the GIN annual conference 2013, held in San Francisco. A list of useful resources on multimorbidity is now available on the website.
The newly established WP is seeking GIN members with an interest in this area to participate in and contribute to the group. The group will conduct business via teleconferences, email discussions and via the GIN website.Aims & Objectives
Chair:Jako Burgers Vice Chair: Martin Scherer
The GIN Board of Trustees established the Overdiagnosis Working Group in August 2014, following a successful meeting organised by Paul Glasziou ahead of the Melbourne conference.
Globally there is increasing concern about the impact of “overdiagnosis” on both the overtreatment of patients and as a major contributor to rising health care costs. Recent activities in this area include the ABIM’s Choosing Wisely campaign (www.choosingwisely.org/), JAMA Internal Medicine’s “Less is More” series, the BMJ’s Too Much Medicine series (www.bmj.com/too-much-medicine) and the controversy over the expanded definitions of psychiatric illness in the recent DSM-5 release (www.psychologytoday.com/blog/dsm5-in-distress).
Currently we have no specific rules or guidance on when and how the definitions of diseases should be modified. A recent study published in PLOS Medicine [Moynihan, 2013]] highlighted the tendency of disease definitions to widen: of 16 guidelines on 14 common conditions, 10 proposed changes widening, 1 narrowing definitions, and 5 were unclear. The widening fell into three categories: creating ‘‘pre-disease’’ (such as pre-hypertension and pre-clinical Alzheimer’s); lowering diagnostic thresholds or boundaries (such as diabetes, and depression); and proposing earlier or different diagnostic methods (such as single scan diagnosis for multiple sclerosis). None of the 16 guidelines included a rigorous assessment of potential harms of proposed definitions changes. There were also considerable conflicts of interest within the committees, including the committee chairs.
Aims & Objectives
About Performance Measures
Performance Measures (PM) are a tool that may help to appraise the quality of care and to support quality improvement (1,2). PM might be rate based or detecting sentinel events. Measuring health care structures, processes and outcomes, patient reported experience or outcome measures are important. PM are often not very clear-cut defined: “performance measure”, “clinical indicator”, “quality indicator” and “performance indicator” are sometimes used interchangeably, which might be overcome by a strict methodological concept.
(1)The Joint Commission on Accreditation of Healthcare Organizations(JCAHO). Characteristics of clinical indicators. QRB Qual Rev Bull. 1989;15(11):330–9.(2)K Edward and H. Jermy, Health care quality indicators project conceptual framework paper. 2006: OECD Health Working Papers: 23, https://www.oecd.org/els/health-systems/36262363.pdf.
The GIN Performance Measures Working Group (PMWG) was set up 2012 to strengthen the link between evidence-based guideline recommendations and evaluation of quality improvement by performance measures. It has the following aims:
1. To improve reporting on development and aims of guideline-based performance measures
The first objective in 2012 was set to develop standards for guideline-based performance measure development. When re-discussed in 2013/2014, the group decided on the development of reporting standards rather than standards because of a lack of a broad common methodological basis for standards.
2. To define requirements to enable guideline-based performance measurement
When discussing methodological standards with an international perspective, the differences of guideline group settings and environment led to the aim to exchange on difference conditions and to learn about different cooperation needs. The aim of this was to successfully develop guideline-based performance measures and to get them implemented.
3. To set methodological standards for high quality guideline-based performance measures
Although planned, the group still did not agree on methodological standards for guideline-based performance measures.
1. The group published 2016 “Reporting standards for guideline-based performance measures.” (Nothacker M, Stokes T, Shaw B, Lindsay P, Sipilä R, Follmann M, Kopp I; Guidelines International Network (G-I-N) Performance Measures Working Group. Reporting standards for guideline-based performance measures. Implement Sci. 2016 Jan 15;11:6. doi: 10.1186/s13012-015-0369-z. PMID: 26772173; PMCID: PMC4714427.)
A comparative review on guideline-based performance measures in different countries found reporting still improvable – and showed very different measures in different countries (Becker M, Breuing J, Nothacker M, Deckert S, Brombach M, Schmitt J, Neugebauer E, Pieper D. Guideline-based quality indicators-a systematic comparison of German and international clinical practice guidelines. Implement Sci. 2019 Jul 9;14(1):71. doi: 10.1186/s13012-019-0918-y. Erratum in: Implement Sci. 2020 May 20;15(1):36. PMID: 31288828; PMCID: PMC6617919.)
2. Group members took part in a qualitative study on experiences with guideline-based performance measures. From this, practical suggestions on how to realise PM could be derived as one result were gathered. Project outline and results were shared and discussed at the 2017 and 2018 GIN conferences (Nothacker M, Bolster M, Steudtner M, Arnold K, Deckert S, Becker M, Kopp I, Schmitt J. International experiences in the development and implementation of guideline-based quality indicators: a qualitative study. BMJ Open. 2021 Jan 9;11(1):e039770. doi: 10.1136/bmjopen-2020-039770. PMID: 33468525; PMCID: PMC7817790.
3. Group members added to the update of a systematic review on approaches of integrating guideline-development and performance measures (Langendam MW, Piggott T, Nothacker M, Agarwal A, Armstrong D, Baldeh T, Braithwaite J, Castro Martins C, Darzi A, Etxeandia I, Florez I, Hoving J, Karam SG, Kötter T, Meerpohl JJ, Mustafa RA, Muti-Schünemann GEU, van der Wees PJ, Follmann M, Schünemann HJ. Approaches of integrating the development of guidelines and quality indicators: a systematic review. BMC Health Serv Res. 2020 Sep 16;20(1):875. doi: 10.1186/s12913-020-05665-w. PMID: 32938461; PMCID: PMC7493171.)
Selected Publications on guideline-based performance measures
Quality Indicator-Manual for oncological Guidelines https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Methodik/QIEP_OL_2021__Version_3_english_version.pdf
Selected further information on methodology of performance measures:
National Quality Forum USA – https://www.qualityforum.org/measuring_performance/measuring_performance.aspx
AAOS, USA – https://www.aaos.org/globalassets/quality-and-practice-resources/quality-performance-measures-resouces/pm_methods_v2.pdf
NICE, UK – https://www.nice.org.uk/standards-and-indicators
GIN members who are interested in joining should write to: email@example.com
Chair – Monika Nothacker
Board Liaison – Zac Munn
Clinical guidelines (CGs) become outdated as new evidence is published and require a periodic reassessment to remain valid. The principles of updating CGs can be a complex, potentially resource intensive, and include three main steps: 1) identifying new evidence; 2) assessing if the new evidence has a potential impact on the current guideline; and 3) reviewing and modifying the guideline.
CGs methodological handbooks include very little guidance about how to review and update guidelines. In general, guideline programmes endorse three years as a reasonable time period to review their guidelines, however, the reality is that most groups struggle to do this every five years.
Some published research has been undertaken about the identification and assessment of new evidence (encompassed sometimes as review, surveillance or monitoring process), even though there is still important areas of uncertainty. Less attention has been paid to the review, modification, and presentation of the recommendations. This is probably due, among other reasons, to the likely assumption that it is similar to the development process. Clearly, more work is required to identify a strategy or suite of strategies that find the “sweet” spot between rigour and feasibility. Sound methodological guidance is still not available to the guideline community.
There have also been developments around a ‘living’ guideline approach and continuous updating but there is still uncertainty around how the methods for facilitating this approach. There is a lot of opportunity to promote collaboration and learning around methods for living guidelines to maximise effort.
There are several international initiatives to improve the process of developing CGs (e.g., GRADE, AGREEII, GLIA, GIN standards or IOM standards), however, these initiatives are failing to fully address the issues pertaining to updating.
We believe that there is a need to prioritise, promote and collaborate between international guideline development and research communities to improve and standardise the updating process. Working jointly with the field of systematic reviewers will also be crucial.
Chair:Emma McFarlane Vice Chair: Hector Pardo-Hernandez