Implementability of Clinical Practice Guidelines: the Review and Development of a Comprehensive Framework for Guideline Implementability (CFGI)

Introduction: We define clinical practice guideline (CPGs) implementability as the characteristics of the guideline that reflect the extent to which it is likely to be adopted in clinical practice. Our objectives were to create a comprehensive and evidence-informed framework of guideline implementability (CFGI). Methods: A mixed-methods approach was used. Based on a systematic literature review of six databases as the foundation, the initial version of the CFGI was created, followed by external consultations to gather feedback and natural language processing tool-assisted classificationto refine the framework. To get external validation of the CFGI from expert feedback at an international conference Results: 15 studies related to guideline implementability were identified from the systematic literature review. The first version of CFGI was compiled, including 6 domains. Feedback on the first version was received from 16 stakeholders, including clinicians, nurses, medical managers, and guideline methodologists, combined with natural language processing tool-assisted classification. The final version of the CFGI is comprised of 6 core domains, containing 21 constructs: (1) Scope and purpose; (2) Clarity and consistency of recommendations; (3) Development and evidence base; (4) Structure and Contents; (5) Development team and transparency; and (6) Implementation environment and tools. Twenty-nine experts participated in the external validation, and the results showed that CFGI had good rationality, importance, clarity, feasibility, and necessity. Conclusions : The development of the CFGI provides a systematic theoretical basis for the development and implementation of future CPGs, which will help to enhance the implementability of guidelines and facilitate their promotion and application in different medical settings. Future research can further validate and apply the CFGI, explore its effectiveness and feasibility in actual operation.