1 national collaborating centre for women’s and children’s health setting standards in antenatal...
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National Collaborating Centre forWomen’s and Children’s Health
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Setting standards in antenatal care
Jane ThomasDirector NCC-WCHHon consultant Obstetrics and gynaecology, Oxford
30.April 2003
National Collaborating Centre forWomen’s and Children’s Health
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Overview
1. NCC-WCH
2. National Standards ANC Children’s National Service Framework National screening committee NICE
Technology appraisals Clinical guidelines
3. Clinical Guidelines
4. ANC guidelines
National Collaborating Centre forWomen’s and Children’s Health
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NCC-WCH
RCOG Evidence Based Clinical Guidelines
RCOG CESU
RCOG Manchester Audit Unit
2002RCOG, RCM, RCPCH, FFPRHC,
AGUM, MSSVD
Consumer
HSR
Funded to produce
guidelines and audit for the NHS
by NICE
National Collaborating Centre forWomen’s and Children’s Health
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NCC-WCH guidelines
Publication
1. Antenatal Care Oct ‘03
2. Infertility Nov ‘03
3. Caesarean section Mar ’04
4. Type 1 Diabetes in children Feb ‘04
5. Long acting reversible contraception Dec 04
National Collaborating Centre forWomen’s and Children’s Health
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National standards for ANC
1. National screening committee
2. National Service Framework
3. NICE Technology appraisals Clinical guidelines National
Service Framework
National Collaborating Centre forWomen’s and Children’s Health
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National standards for ANC
1. National screening committee
2. National Service Framework
3. NICE Technology appraisals Clinical guidelines National
Service Framework
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First Class Service 1998
CHI
National Standards
National Monitoring
NICENational service frame works
Clinical Governance
Lifelong Learning
Continued Professional Development
Local
National Collaborating Centre forWomen’s and Children’s Health
National Collaborating Centre forWomen’s and Children’s Health
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National standards for ANC
National Service Framework National screening committee NICE
Technology appraisals Clinical guidelines
National Collaborating Centre forWomen’s and Children’s Health
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NICE TA and guidelines
NHS clinical guidance based on• Clinical effectiveness• Cost effectiveness
Products• Clinical guideline (⇒Collaborating Centres)• Technology appraisals
National Collaborating Centre forWomen’s and Children’s Health
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What are clinical guidelines?
“systematically developed statements to
assist practitioner and patient decision
about appropriate health care
for specific clinical circumstances’
National Institute of Medicine 1992
National Collaborating Centre forWomen’s and Children’s Health
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Aim of guidelines improve quality + consistency + outcome of
care
promote effective interventions +
discourage ineffective interventions
make efficient use of resources
highlight clinical need/service provision highlight gaps in research reassure clinicians and patients
National Collaborating Centre forWomen’s and Children’s Health
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Key components for guideline validity
1. multi-disciplinary working groups
2. systematic review
3. explicit link of evidence to
recommendations
4. explicit methods
National Collaborating Centre forWomen’s and Children’s Health
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NICE guideline development process
Scope
GDG1.Develop questions
4. Apply evidence
Stakeholder comment
1st Draft Final Draft
Submit
Evidence
GUIDELINE
NCC-WCH2.Systematic review3.Evidence appraisal
DH remit6
12-18
6
Time months
National Collaborating Centre forWomen’s and Children’s Health
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DH remit ANC
" …NHS in England and Wales routine antenatal care for all women
including the number and timing of antenatal visits required and evidence based justification for the scope and content of each.
draw upon the evidence based recommendations of the antenatal subgroup of the National Screening Committee".
National Collaborating Centre forWomen’s and Children’s Health
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ANC scope
Populations• baseline care of all pregnancies.• Comprehensive advice on the antenatal
care of the healthy woman with an uncomplicated singleton pregnancy
Settings- all NHS
National Collaborating Centre forWomen’s and Children’s Health
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ANC scope
guidance on antenatal visits antenatal screening educational aspects of antenatal
care that are relevant to the antenatal health of the woman.
communication issues that influence the ability of women to make informed decisions
National Collaborating Centre forWomen’s and Children’s Health
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ANC scope-what’s excluded
The investigation and management of complications arising in pregnancy
Any aspect of intrapartum and postpartum care
National Collaborating Centre forWomen’s and Children’s Health
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GDG:Group leader: Peter Brocklehurst
2 midwives2 GP’s2 obstetricians a paediatrian a radiolographer2 consumer representatives
NCC-WCH methodological support
ANC guideline group
1st GDG meeting June 021st Draft consultation: Apr 03Publication: Oct 03
National Collaborating Centre forWomen’s and Children’s Health
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Classification of Evidence Levels
Ia Evidence obtained from meta-analysis of randomised
controlled trials
Ib Evidence obtained from at least on randomised controlled
trial
IIa Evidence obtained from at least one well-designed
controlled study without randomisation
IIb Evidence obtained from at least one other type of well-
designed quasi-experimental study
III Evidence obtained from well-designed non-experimental
descriptive studies, such as comparative studies, correlation
studies and case studies
IV Evidence obtained from expert committee reports or
opinions and/or clinical experience of respected authorities.
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Grades of Recommendations
A Requires at least one randomised controlled trial as part of a body of
literature of overall good quality and consistency addressing the specific
recommendation.
(Evidence levels Ia, Ib)
B Requires the availability of well controlled clinical studies but no randomised
clinical trials on the topic of recommendations.
(Evidence levels IIa, IIb, III)
C Requires evidence obtained from expert committee reports or opinions
and/or clinical experiences of respected authorities. Indicates and absence
of directly applicable clinical studies of good quality. (Evidence level IV)
Good Practice Point
Recommended best practice based on the clinical experience of the
guideline development group
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Timetable ANC
1st GDG meeting June 02
1st draft consultation: 14 Apr-11 May
2nd draft consultation: 16 Jun-11 July
Publication: 23rd Oct 2003
National Collaborating Centre forWomen’s and Children’s Health
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Guidelines and NICE TA
Guidelines incorporate NICE’s TA recommendations, • Rhesus anti D prophylaxis.
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Guideline + NSF
Complement the recommendations of the NSF.
It will support the implementation of the NSF.
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NICE guidelines
3 formats• Full• NICE short form• Patient version
Audit standards CHAI Research recommendations
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Up to date information about the NCC-WCH and guidelines is available from
http://www.nice.org.uk/
Thank you