The Clinical Working Group

The Clinical Working Group chaired by Dr. Denise Campbell-Scherer is a group of individuals responsible for reviewing the current evidence and developing the comprehensive care paths/maneuvers used in BETTER.

In order to review the evidence, the members of the Clinical Working Group were divided into teams, which included clinicians, content experts, researchers, and end-users.  These teams focused their review of the evidence in the following areas: breast cancer, cervical cancer, colorectal cancer, skin cancer, lung cancer, cardiovascular disease, diabetes, alcohol, mental health, lifestyle (tobacco, alcohol, nutrition and physical activity), obesity (waist circumference, BMI) and family history.

Guideline Challenge – The Clinical Working Group

Chronic disease prevention and screening maneuvers are summarized in clinical practice guidelines.  However, their effectiveness as tools to facilitate translation of evidence into practice has been inconsistent.  One possible reason for this is that clinical practice guidelines tend to focus on a single disease or condition and are often generated in highly selected populations, which are not always generalizable to primary care patients.  What’s more, there is a plethora of clinical practice guidelines on the same topic, many lacking rigor, including conflicting guidelines that can confuse primary care providers .

Built from the work of the Guidelines Advisory Committee at the Centre for Effective Practice, the Clinical Working Group employed a process to assess the evidence for chronic disease prevention and screening interventions for patients aged 40-65.  An adaptation of the Knowledge to Action (KTA) Framework was employed and evolved to accommodate the inclusion of primary prevention and screening for the multiple target conditions involved in BETTER – diabetes, cardiovascular disease, cancer (cervical, breast and colorectal) and their associated lifestyle factors – The BETTER Guideline Synthesis framework.  This iterative process was used to select high quality practice guidelines and decide which recommendations to implement in BETTER.

Evidence-Based Maneuvers

Through their review of the evidence, the Clinical Working Group identified evidence-based maneuvers which were included as part of the BETTER comprehensive approach to chronic disease prevention and screening:

  • Cardiovascular disease: lipid profile, blood pressure, Framingham Risk Chart, body mass index and waist circumference
  • Diabetes: blood sugar
  • Cancer: breast, cervical and colorectal screens
  • Common lifestyle factors to chronic diseases: physical activity, alcohol, diet/nutrition, smoking cessation

A total of 28 evidence-based maneuvers were identified by the Clinical Working Group and included as part of BETTER’s primary outcome measure, the Summary Quality Index or SQUID.  Several other relevant and coherent deliverables were also developed by the Clinical Working Group including comprehensive care paths for each chronic disease prevention and screening maneuver, training materials for primary care providers and prevention visit tools.  For a description of the tools and resources identified and developed by the Clinical Working Group, please see the BETTER resources.



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