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F Examples of Questionnaires for Use in Priority Setting This appendix includes two questionnaires that the Forum on Quality and Effectiveness in Health Care might use to make better use of expert judgment in selecting topics for practice guidelines. Each is suggested for consideration rather than for adoption without further revision. The first example is adapted from a questionnaire used by the Forum before one meeting it convened to obtain practitioners' nomination and assessment of potential guidelines topics in a broad clinical area. Respondents later met to discuss the results and rank topics. The second example is the latest draft of a questionnaire developed by David Eddy for testing at Kaiser Permanente of Southern California TOPIC). For illustrative purposes, it includes sample responses for a real topic. The questionnaire focuses on a single topic so a respondent would have to fill out several questionnaires if he or she was being asked to nominate more than one topic. 151
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152 Instructions SETTING PRIORITIES FOR CLINICAL PRACTICE GUIDELINES PRIORITY-SETTING QUESTIONNAIRE NO. 1 ADAPTATION OF FORM USED BY AHCPR A. Please list in order of importance the five clinical topics you would recommend to the Forum as subjects for guidelines development. Be as precise about the topics as you can (e.g., management of postoperative pain rather than management of pain). B. After each topic, first rate its importance in terms of each of the identified criteria (1 = very important, 2 = somewhat important, 3 = somewhat unimportant, 4 = very unimportant). C. Then, rate the prospect that a guideline would make recommendations that would change practitioner or patient behavior in ways that would reduce illness burden, cost, or variability of practice (1 = very likely, 2 = likely, 3 = somewhat unlikely, 4 = very unlikely). D. Next, rate the availability of scientific evidence on which to base practice recommendations (1 = good, 2 = somewhat limited, 3 = poor). Questions Topic Criterion Illness burden Cost Variability in practice Prevalence Relevance to Medicare Relevance to Medicaid ImportanceProspects for change (1 - , see instructions) (1 - , see instructions) Availability of relevant scientific evidence (1-3, see instructions) Are sound existing guidelines available? Yes/No/Don't Know (circle one) If yes, please identify source: 2. [Repeat for additional topics.]
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APPENDLY F 153 PRIORITY-SETTING QUESTIONNAIRE NO. 2 FORM USED BY KAISER PERMANENTE, SOUTHERN CALIFORNIA WITH ILLUSTRATIVE RESPONSES (check one) Practice guidelines Process guidelines Interviewee's name Interviewer's name PRACTICE GUIDELINES PRIORITY-SETTING FORM (VERSION 3.4) BACKGROUND Kaiser Permanente, Southern California is currently screening about 5 percent of healthy newborns for hearing loss. The recent MIH Consensus Guideline on Hearing Screening in Infants and Children recommends that ALL newborns be screened before 3 months of age. We anticipate that without farther advice given to our physicians, the number of healthy newborns screened will increase to about 50 percent. Based on our understanding of the literature, this change in practice may not be justified. Therefore, we propose to develop a comprehensive analysis of hearing screening in healthy newborns. 1. Disease condition or problem: Early detection of hearing impair~nentin newborns 2. Patient group: Healthy newborns 3. What are the treatment options? 4. Option 1 to be assessed: 5. Option 2 to compare with Option 1: 6. Practitioner who will give Option 7. Setting for Option 1:
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154 8. Type of activity SETTING PRIORITIES FOR CLINICALPRACTICE GUIDELINES Primary prevention and/or screening (detection) O Diagnostic ~ Treatment 9. individual or group who could sponsor the guidelines: 10. Description of sponsor's priority for this guideline. 11. Number of members who are candidates for Option 1 each year: 12. Most important outcomes affected by Option 1 or the alternatives (benefits and harms): 1. 1 13. Change in per-person probability of each health outcome with Option 1 versus Option 2 (note: a negative sign means Option 1 decreases the probability of the outcome): a. Estimated per-person probability of each outcome occurring under Option 1: b. Estimated probability of each outcome occurring under Option 2: 1 1 1 1 1 1 c. Change in probability (line 13a minus line lab) under Option 2: r 1 1 1 1 1
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APPENDIX F 14. Change in cost a. Cost of providing Option 1: b. Cost of providing Option 2: c. Change in cost (line 14a minus 14b): 155 Note: if either option has a relatively large effect on long-term costs (large relative to the effect on short-term costs), indicate this with a plus (+) or minus (-3 sign in the box after the cost figure. 15. Probability that a formal analysis ofthe available evidence would show that Option 1 is preferable to Option 2: 1 1 16. Describe the quality of the evidence in terms of the research designs (e.g., randomized controlled trials, randomized not controlled, clinical series, no direct evidence). 17. Expected effect of a guideline on use of Option 1 versus Option 2: a. Estimated proportion of candidates who would be treated with Option 1 if current trends continue (without a new guideline): b. Estimated proportion of candidates who would be treated with Option 1 if a new guideline were developed recommending Option 1: 1 1 c. Estimated proportion of candidates who would be treated with Option 1 if a new guideline were developed recommending Option 2: 1 1
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156 SEITING PRIORITIES FOR CLINICAL PRACTICE GUIDELINES d. Expected effect of a guideline on use of Option 1 versus. Option 2: (~(line 15 multiplied by line 17b) + (1 minus line 15) multiplied by line 17c)] minus line 17a) l l 18. Number of analyst full-time equivalents needed to produce a guideline: 19. Expected effect of the guideline on outcomes: (1) line 11 multiplied by line 13c multiplied by line 17d (Note: If the value is positive, the outcome occurs for those lives. If the value is negative, the outcome does not occur for those lives.) a b c d e 1 2 (2) line 11 multiplied by line 14c multiplied by line 17d 20. How much does it cost to deal with each of the benefits or harms? [ T I 1 1 1 21. Cost of the benefits arid banns of implementation per year (line 11 multiplied by line 14c multiplied by line 1 7d multiplied by line 20~. A negative number is money saved. 1 1 1 1--- 1 22. Revised total cost: (Dunn of item 19 plus the rows in item 20)
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