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The aim of STANDING Collaboration is to establish – for the first time in Australia – nationally agreed sets of clinical indicators for a range of medical conditions, using a process characterised by three key features:

  • a single open and collaborative process which allows health care professionals and consumers to fine-tune indicators using their experience
  • logging the source and provenance of clinical indicators for transparency
  • use of a live and online wiki-based platform to facilitate ongoing review to keep indicators up to date

The outcomes from STANDING Collaboration will be:

  1. Clinical standards and point-of-care indicators for the basic care of common conditions and procedures, based on current guidelines and best available evidence.
  2. Proof of concept of the wiki process for the development and updating of clinical standards and indicators.
  3. Recommendations and specifications for data inputs and extraction processes for electronic medical records and hand-held devices.
  4. Future potential to embed standards and indicators in tools as clinical decision support systems for healthcare providers and consumers, and to evaluate the effects of their implementation using “step-wedge” research design.

The problem

Our CareTrack Australia study showed that Australians receive recommended care only about half the time1, and outlined a plan for facilitating more appropriate care2. An essential first step is to get agreement on what constitutes appropriate care. Over 600 clinical practice guidelines (CPGs) are available in Australia3 and over 2000 in the US4. Whilst these provide an excellent resource they have several serious limitations (currency, usability, format, and coverage) and they do not, in any practical sense, guide everyday care2. The other widely used resource, the Internet, does as much to confuse and mislead as to enlighten, and also suffers bias from vested interests.

Our plan proposes an inclusive, transparent, curated wiki-based process for, initially, reaching agreement on, and, subsequently for keeping up to date, clinical standards for the basic care for common conditions and procedures, based on current guidelines and best available evidence2. It proposes the development of clinical standards, embodied in clinical indicators, which will be presented as clinical tools2 to inform patients and providers, guide care, document that it has been delivered (or why it has not), and allow electronic audit so that feedback can be provided from individual to jurisdictional levels. A start will be made with the conditions low back pain and hypertension, and procedures for airway management.

1 Runciman WB, Hunt TD, Hannaford NA, Hibbert PD, Westbrook JI, Coiera EW, et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Med J Aust. 2012;197(2):100-5.

2 Runciman WB, Coiera EW, Day RO, Hannaford NA, Hibbert PD, Hunt TD, et al. Towards the delivery of appropriate health care in Australia. Med J Aust. 2012 16.7.2012;197(2):78-81.

3 National Health and Medical Research Council. Clinical practice guidelines portal (website). Available at: http://www.clinicalguidelines.gov.au. Accessed October 26th, 2016.

4 U.S Department of Health and Human Services. 2016. Agency for healthcare Research and Quality. Available at: https://guideline.gov/browse/clinical-specialty. Accessed October 26th, 2016.