Table 1.

Guideline implementability framework

Domain	Definition	Element	Examples
Adaptability	The guideline is available in a variety of versions for different users or purposes	Sources	Internet, peer reviewed journal
		Versions	Full text, summary, print, digital
		Users	Tailored for patients or caregivers
Useability	Content is organized to enhancethe ease with which the guideline can be used	Navigation	Table of contents
		Evidence	Narrative, tabulated or both
		Recommendations	Narrative, graphic (algorithms) or both; Recommendation summary (single list in full or summary version rather than dispersed)
Validity	Evidence is summarized and presented such that its quantity and quality are apparent	Number of references	Total number of distinct references to evidence upon which recommendations are based
		Evidence graded	A system is used to categorize quality of evidence supporting each recommendation
		Number of recommendations	Total number of distinct recommendations
Applicability	Information is provided to help interpret and apply guidelines for individual patients	Clinical considerations	Information such as indications, criteria, risk factors, drug dosing that facilitates application of the recommendations explicitly highlighted as tips or practical issues using sub-titles or text boxes, or summarized in tables and referred to in recommendations or narrative
Communicability	Resources for providers or patients to inform, educate, support and involve patients	Inform, educate, support	Informational, educational or supportive resources for patients/caregivers, or contact information (phone, fax, email or URL) for such resources
		Decision making	Questions or tools for clinicians to facilitate discussion with patients, or decision aids to support patient involvement
Relevance	The focus or purpose of the guideline is explicitly stated	Objective	Explicitly stated purpose of guideline (clinical, education, policy, quality improvement)
		Stakeholders	Specify who would deliver (individuals, teams, departments, institutions, managers, policy makers, internal/external agents) and receive the services (specify type of patients)
		Needs	Identification of stakeholder needs, perspectives, interests or values
Accommodation	Anticipated changes, resources and competencies required to adapt and accommodate guideline utilization are identified	Technical	Equipment or technology needed, or the way services should be organized
		Regulatory	Industrial standards for equipment or technology, or policy regarding their use
		Human resources	Type and number of health professionals needed to deliver recommended services
		Professional	Education, training or competencies needed by clinicians/staff to deliver recommendations
		Workflow	Anticipated changes in workflow or processes during/after adoption of recommendations
		Costs	Direct or productivity costs incurred by acquiring resources or training to accommodate guidelines, or as a result of service reductions during transition from old to new processes
Implementation	Processes for planning and applying local strategies to promote guideline utilization are described	Identify barriers	Individual, organizational, or system barriers that could challenge adoption, or instructions for local needs assessment of guideline users
		Tailor guideline	Instructions, tools or templates to tailor guideline/recommendations for local context
		Integrated tools	Point-of-care templates/forms (clinical assessment, standard orders) to integrate guidelines within care delivery processes
		Promote utilization	Possible mechanisms by which to promote guideline utilization
Evaluation	Processes for evaluating guideline implementation and utilization are described	Implementation	Methods for evaluating the implementation process
		Utilization	Audit tools or performance measures/quality indicators to assess the organization, delivery and outcomes of guideline recommended care