The Health Information and Quality Authority (HIQA) has signed a contract with the Health Research Board (HRB) to provide the evidence for clinical guidelines that are developed for the National Clinical Effectiveness Committee (NCEC). The five-year contract, worth €2.25 million, will establish the HRB-Collaboration in Ireland for Clinical Effectiveness Reviews (HRB-CICER).

The NCEC quality assures National Clinical Guidelines for use in healthcare in Ireland. The goal of these guidelines is to promote healthcare that is current, effective and consistent, ensuring the best possible outcomes for patients. To achieve this, the guidelines must be based on the best available scientific evidence of clinical benefits and cost-effectiveness and incorporate the budget impact of their implementation.

HRB-CICER will undertake evidence reviews and provide scientific support for the development of the NCEC’s National Clinical Guidelines. The HRB-CICER team will comprise a dedicated multidisciplinary research team supported by staff from HIQA and RCSI (Royal College of Surgeons in Ireland), as well as national and international clinical and methodological experts. The team will collaborate closely with the multidisciplinary Guideline Development Groups to ensure that their work can be used to inform evidence-based recommendations.

HIQA’s Director of Health Technology Assessment and Deputy Chief Executive, Dr Máirín Ryan, said “Clinical guidelines are important tools to enable clinicians to drive quality, safety and best use of available resources in healthcare. It is important that accurate and reliable evidence is used to develop clinical guidelines. This contract will ensure that the best available evidence is used to support the development of National Clinical Guidelines. This will mean that the public can be assured that the use of National Clinical Guidelines by healthcare providers will optimise outcomes for patients.”

“The expertise of HIQA in reviewing clinical effectiveness, safety and the economic aspects of healthcare interventions means that it is ideally positioned to lead the HRB-CICER collaboration. Our main collaborator, the HRB Centre for Primary Care Research at RCSI, has a strong track record in the conduct of systematic reviews of clinical effectiveness, including several Cochrane reviews. The establishment of HRB-CICER will also see the creation of five new specialised positions to help HIQA in its expanded role.”

“While HIQA has informally supported the work of NCEC since the development of the first National Guideline, this was not sustainable without structured resources and strategic direction. The establishment of HRB-CICER will mean that there are sufficient resources and appropriate structures to support the provision of the best available evidence needed to develop high-quality guidelines that will improve patient health.”

Speaking about the award, HRB Chief Executive, Dr Graham Love, said “We need to build public trust and confidence that care in our health service is based on the latest thinking and delivered in line with international standards. This HRB funded project will deliver solid evidence and an economic case to implement robust, reliable clinical guidelines quickly. This will equip health professionals with the know-how they need to deliver care and build patient confidence that they are receiving care in line with best international standards.”

Speaking on the announcement of the funding, Professor Susan Smith, Professor of Primary Care Medicine at RCSI and the Clinical Lead of the HRB CICER, said “The funding and establishment of the HRB CICER is a welcome development in providing clinicians and researchers the opportunity to engage in the generation of evidence to support clinical colleagues and improve outcomes for our patients.”

Professor Smith, who as Clinical Lead of the HRB CICER will provide support on selection of clinical endpoints, interpretation of clinical effectiveness, and quality assurance of outputs, also added “RCSI are delighted to be working alongside HIQA on this five year project, with a number of RCSI staff supporting the project such as Professor Tom Fahey, Principal Investigator of the HRB Centre for Primary Care Research in RCSI, who will provide methodological and clinical expertise in evidence synthesis and Kate Kelly, Chief Librarian in RCSI, who will support information retrieval and search methods for the systematic reviews.”

Ends.

Further Information: 

Marty Whelan, Head of Communications and Stakeholder Engagement, HIQA, 01 814 7480 / 086 2447 623, mwhelan@hiqa.ie

Notes to the Editor: 

The Health Research Board (HRB) supports excellent research that improves people’s health, patient care and health service delivery.  HRB aims to ensure that new knowledge is created and then used in policy and practice.  In doing so, it supports health system innovation and create new enterprise opportunities.

In March 2016, the HRB issued a call for organisations to bid to provide the evidence synthesis required to inform the development of National Clinical Guidelines and National Clinical Audit over a five year period for a budget of €2.25 million.

The organisation selected was to establish a Collaboration in Ireland for Clinical Effectiveness Reviews (CICER), harnessing existing strengths in evidence synthesis nationally and potentially internationally. HRB-CICER was to synthesise the evidence on clinical effectiveness, cost-effectiveness, resource implications and budget impact and provide broader support to the clinical guideline and clinical audit development groups.

HIQA submitted an application to establish HRB-CICER through the competitive grant application process. Applications were reviewed by an independent academic panel established by HRB, and at least three selected applicants were invited for interview. The grant was awarded to HIQA following approval of the panel’s recommendations by the board of HRB in September 2016.

The sixteen member co-applicant and collaborator team represents a broad range of disciplines with extensive experience in systematic reviewing, statistical analysis, health economic and budget impact analysis, clinical guideline and standards development, and related academic expertise in clinical research and practice, research methodology, statistics, psychology and education.

HIQA’s main collaborator is the HRB Centre for Primary Care Research (HRB-CPCR), Department of General Practice, Royal College of Surgeons in Ireland (RCSI). HRB-CPCR has a strong track record in the conduct of systematic review of clinical effectiveness including several Cochrane reviews, which are internationally recognized as the highest standard of systematic reviews of primary research in human health care and health policy. HRB-CPCR also has experience engaging with national decision makers to inform policy decisions and providing research and training opportunities to researchers across a wide range of disciplines. HRB-CPCR is led by Professor Tom Fahey and Professor Susan Smith. Professor Smith has a long track record of working with HIQA serving as a member of the HTA Scientific Advisory Group and several HTA Expert Advisory Groups.

Collaborators from RCSI and NUI Maynooth will provide expertise in systematic reviewing, in particular for more complex review methodology around diagnostic accuracy, risk prediction, meta-regression and qualitative synthesis. RCSI will provide senior-level information scientist expertise through Chief Librarian Kate Kelly. Other collaborators include Professor Michael Barry, National Centre for Pharmacoeconomics; Professor Marianne Klemp, Norwegian Knowledge Centre; Prof Mike Drummond, University of York, who chaired one of NICE’s Guideline Review Groups for ten years and contributed to development of NICE processes; Professor Michael Turner, Clinical Lead of the National Programme for Obstetrics and Gynaecology; and Professor Aine Carroll, Director of Clinical Strategy and Programmes, HSE.

The CICER research team will be based at two sites: HIQA and HRB-CPCR at RCSI. The team will comprise the following:

·         Director of CICER (Dr Mairin Ryan, Director of HTA, HIQA)

·         Clinical Lead (Professor Susan Smith, Professor of Primary Care Medicine, RCSI)

·         CICER Programme Manager (HIQA)

·         Post-doctoral scientist/Systematic Reviewer (RCSI)

·         Information Scientist/Systematic Reviewer (HIQA)

·         Statistician (HIQA)

·         Health Economist (HIQA)

Clinical Guidelines are defined as systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances, across the entire clinical spectrum. Clinical guidelines provide guidance and standards for improving the safety, quality and cost-effectiveness of healthcare delivered to patients.

The National Clinical Effectiveness Committee (NCEC) was established by the Minister for Health in September 2010 as part of the Patient Safety First Initiative. National Clinical Guidelines quality assured by the NCEC are mandated by the Minister for Health for implementation by the HSE.

National Quality Assurance Criteria for Clinical Guidelines used by the NCEC include a requirement that the recommendations in the guidelines are supported by the best available evidence on clinical and cost-effectiveness and take account of the budget impact of implementation of the guideline. HRB-CICER will produce this evidence to support the Guideline Development Groups in their work.

There are currently fourteen National Clinical Guidelines. Examples include guidelines on the Early Warning Score to monitor the acutely deteriorating patient and guidelines on management of healthcare acquired infections, for example, MRSA.