OBJECTIVES: The main aim of this project was to enhance compliance with the best available evidence in clinical practice guidelines (CPGs) development based on evidence-based healthcare (EBHC) and GRADE (grading of recommendations, assessment, development and evaluation) principles in healthcare professionals and healthcare providers. INTRODUCTION: In various healthcare fields, the quality of care provided in different healthcare settings may vary. Guidelines following the EBHC principles should help make the right decisions in healthcare by providing the best healthcare option and be available for all patients. The perspectives of all engaged stakeholders should be respected, however. Within the Czech Republic, there had been no standardized process of CPG development. METHODS: A baseline audit was conducted to demonstrate the status quo of the EBHC in the Czech Republic, which identified several barriers. Consequently, strategies (educational activities, methodological guidelines) to overcome the barriers were suggested and implemented. Two more audits followed (November 2017, November 2020). RESULTS: The baseline audit results showed no or very low compliance to the best available evidence in CPG development. After the implementation, an increased compliance in all audit criteria (national methodology guidelines, trustworthy CPGs, experienced methodologists, clinical summaries) has been reported. The project has helped to establish procedures of CPGs development, enhanced knowledge and skills on EBHC in healthcare professionals, and ignited patients' involvement in CPG development. CONCLUSIONS: The implementation project showed an increasing number of national methodology guidelines, CPGs being developed using EBHC and GRADE principles and HC professionals educated in EBHC. A national center for CPGs development within the Ministry of Health is being planned to sustain the project achievements.

Czech Health Research Council

Department of Health Sciences Faculty of Medicine Masaryk University Brno

Institute of Health Information and Statistics of the Czech Republic Czech Republic

The Czech Republic Centre for Evidence Based Healthcare The Joanna Briggs Institute Centre of Excellence Czech National Centre for Evidence Based Healthcare and Knowledge Translation Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno

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Alonso-Coello P, Schünemann HJ, Moberg J, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1. Introduction. BMJ 2016; 353:i2016 doi:10.1136/bmj.i2016. DOI

Suchý M, Bednařík J, Škoda O, Voháňka S, Ehler E, Pátá M. Vývoj Národní sady klinických standardů a ukazatelů zdravotní péče a první výsledky v oboru neurologie [Development of National clinical standards and indexes of healthcare and first results in neurology field]. Cesk Slov Neurol N 2010; 73:569–577.

Univerzita Palackého v Olomouci, Marečková J, Klugarová J, Klugar M, Zeleníková R, Gurková E, Jarošová D. Zdravotnictví založené na vědeckých důkazech [Evidence-based Health Care]. 2015.

Schünemann H, Brożek J, Guyatt G, Oxman A. GRADE Handbook. Published 2013. Available at: https://gdt.gradepro.org/app/handbook/handbook.html [Accessed 14 September, 2021].

Guyatt GH. GRADE guidelines. 8. Rating the quality of evidence-indirectness. J Clin Epidemiol 2011; 64:1303–1310. doi: 10.1016/j.jclinepi.2011.04.014. DOI

ÚZIS ČR. KDP (online). Published 2020. Available at: https://kdp.uzis.cz/index-en.php?pg=about-us [Accessed 14 September, 2021].

Klugar M, Klugarová J, Pokorná A, et al. Czech national project ‘Clinical Practice Guidelines’ methodology and current results. Int J Evid Based Healthc 2019; 17: (Suppl 1): S3–S5.

Klugar M, Klugarová J. Using evidence synthesis and clinical practice guidelines in everyday decision-making process: is it real or a dream? Int J Evid Based Healthc 2019; 17: (Suppl 1): S1–S2.

Klugar M, Klugarová J, Pokorná A, Ličeník R, Mužík J, Dušek L. Metodické postupy pro vytvoření a posuzování nově vytvořených KDP. Verze 2.1. [Czech methodological guidelines for development and assessment of clinical practice guidelines. Version 2.1.]. Published online 2020. Available at: https://kdp.uzis.cz/res/file/metodika/metodicke-postupy-pro-vytvoreni-a-posuzovani-nove-vytvorenych-kdp_v2.1.pdf

JBI; 2020; Porritt K, McArthur A, Lockwood C, Munn Z. JBI Manual for Evidence Implementation.

Pokorná A, Dušek L, Búřilová P, Klugar M. Metodika tvorby a zveřejňování návrhů KDP a formuláře tvorby klinických doporučených postupů (KDP) [Methodological guidelines for development and publishing clinical practice guidelines and Clinical Practice Guidelines (CPG) development forms]. Available at: https://kdp.uzis.cz/res/file/metodika/metodika-tvorby-a-zverejnovani-navrhu-kdp-a-formulare-tvorby-klinickych-doporucenych-postupu.pdf

Klugar M, Kantorová L, Pokorná A, et al. Visual transformation for guidelines presentation of the strength of recommendations and the certainty of evidence. J Clin Epidemiol 2021; 143:178–185.

Schünemann HJ, Zhang Y, Oxman AD. Distinguishing opinion from evidence in guidelines. BMJ 2019; 366:l4606.

Zhang Y, Coello PA, Guyatt GH, et al. GRADE guidelines. 20. Assessing the certainty of evidence in the importance of outcomes or values and preferences–inconsistency, imprecision, and other domains. J Clin Epidemiol 2019; 111:83–93.

Stacey D, Légaré F, Lewis K, et al. Decision aids to help people who are facing health treatment or screening decisions. Cochrane Database Syst Rev 2017. CD001431 doi:10.1002/14651858.CD001431.pub5. DOI

SIGN (Scottish Intercollegiate Guidelines Network). SIGN – Who we are. Available at: https://www.sign.ac.uk/about-us/timeline/ .

NICE (National Institute for Clinical Excellence). History of NICE. Available at: https://www.nice.org.uk/about/who-we-are/history-of-nice .

Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. Can Med Assoc J 2010; 182 (18):E839–E842.

NICE. Developing NICE guidelines: the manual. Published online 2020. Available at: https://www.nice.org.uk/process/pmg20/chapter/introduction

JBI; 2020; Aromataris E, Munn Z. JBI Manual for Evidence Synthesis.

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372:n71.

Monkeypox Knowledge and Vaccine Hesitancy of Czech Healthcare Workers: A Health Belief Model (HBM)-Based Study