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Formulating recommendations to increase appropriateness and efficiency in healthcare: the MAPAC initiative

Date and Location




Sunday 22 September 2013 - 15:30 - 17:00


Presenting author and contact person

Presenting author

Ivan Solà

Contact person

Ivan Solà
Abstract text
Background: Appropriateness in healthcare is not always warranted and some clinical practices do not integrate the available evidence with the resources required to implement it. For these reasons it is essential to promote initiatives that try to reduce inefficiency. Objectives: To describe an initiative set at an University Hospital in Barcelona (Spain) that aims to reduce inappropriate clinical practices in terms of: i) lack of effectiveness or supported by inconclusive evidence; ii) lack of efficiency or with an unclear trade-off between desirable (benefits) or undesirable (harms or costs) effects. Methods: The Committee for the Clinical Practice and Healthcare Appropriateness (MAPAC for the acronym in Spanish) is a multidisciplinary working group that, with the support of the Iberoamerican Cochrane Centre and the Hospital’s Epidemiology Department, aims to identify inappropriate clinical practices and formulate explicit recommendations to reduce inefficiency. The Committee identifies and prioritises the practices to be evaluated in collaboration and with the involvement of Hospital healthcare professionals. Each clinical practice derives in a clinical question that originates recommendations formulated following GRADE methodology to classify the quality of evidence and to grade their strength. The recommendations also incorporate local factors as the availability of alternative guidelines or the burden and direct costs derived of the use of each clinical practice at the Hospital. All recommendations are submitted to the Hospital Management Board with a set of actions to improve the appropriateness of the assessed practices. Once approved the actions are widely disseminated within Hospital healthcare professionals. The actions are periodically monitored to value possible additional actions. Results and Conclusions: So far the Committee has produced recommendations for 22 clinical practices in advanced cancer, medication utilisation, diagnostic and laboratory tests, or surgical procedures. We will select some illustrative examples of the working experience and will discuss strengths and drawbacks of the initiative.