RAPADAPTE

RAPADAPTE is a NEOLOGISM that you may not have heard of yet.

Here’s the short version: RAPADAPTE is a methodology for rapid efficient development of high-quality clinical guidelines.

Here’s the long version: In 2010 a national governmental body in Costa Rica expressed a need to create a national guideline on breast cancer treatment and wanted it completed within six months with a limited budget. In June 2011, faced with an overwhelming challenge, a team from the International Health Central American Institute Foundation (Mario Tristan, Anggie Ramirez-Morera, and Arturo Salazar) piloted a new method for approaching such a task for a single recommendation to determine that such a challenge could be met.

From July 24, 2011 through January 15, 2012 this team organized 63 experts from 8 disciplines to produce 90 evidence-based recommendations. They initially wanted to use the ADAPTE method to locally apply recommendations adapted from well-produced guidelines. The used SIGN and Catalan guidelines which were identified using a SATISFICING approach, but as these guidelines were published on or before 2008 it was felt that systematic reviews would be too outdated to rely on this for a current national guideline.

Systematic reviews for 90 recommendations would take years so they adapted the ADAPTE thinking to use evidence that was systematically identified and critically appraised in evidence databases (DynaMed and EBM Guidelines). DynaMed provided the comprehensive evidence identification and critical appraisal needed for 85 of the 90 recommendations, and double-checking for 12 recommendations confirmed this. The produced a comprehensive guideline in 5 months (finalizing it January 15, 2012) and comparable guidelines have taken 24 to 44 months to complete.

In 2012 Mario asked me to help present this at a conference and that introduced me to the Guidelines International Network (the leading organization for guideline developers). We have subsequently become a G-I-N member and offer substantial networking and support for to hundreds of guideline developers. Anyway, for that presentation of what was accomplished we coined the term RAPADAPTE as a rapid adapted ADAPTE. Several audience members from Europe and the Middle East asked for the RAPADAPTE methodology in English.

We recruited two additional leaders in systematic reviews and guideline development (Esther J van Zuuren from the Netherlands, and Zbys Fedorowicz from Bahrain) and developed a manuscript to explain what happened in Costa Rica, what was learned from it, and derived a 12-step RAPADAPTE methodology.  This manuscript was accepted for publication by the International Journal for Quality in Health Care earlier this week so we are looking forward to sharing RAPADAPTE with the world in the coming months. (now published here)