Objective: To develop a guideline document model
that includes a sufficiently broad set of concepts to be useful throughout the
guideline life cycle.
Design: Current guideline document models are limited in that they
reflect the specific orientation of the stakeholder who created them; thus,
developers and disseminators often provide few constructs for conceptualizing
recommendations, while implementers de-emphasize concepts related to
establishing guideline validity. The authors developed the Guideline Elements
Model (GEM) using XML to better represent the heterogeneous knowledge
contained in practice guidelines. Core constructs were derived from the
Institute of Medicine's Guideline Appraisal Instrument, the National Guideline
Clearinghouse, and the augmented decision table guideline representation.
These were supplemented by additional concepts from a literature review.
Results: The GEM hierarchy includes more than 100 elements. Major
concepts relate to a guideline's identity, developer, purpose, intended
audience, method of development, target population, knowledge components,
testing, and review plan. Knowledge components in guideline documents include
recommendations (which in turn comprise conditionals and imperatives),
definitions, and algorithms.
Conclusion: GEM is more comprehensive than existing models and is
expressively adequate to represent the heterogeneous information contained in
guidelines. Use of XML contributes to a flexible, comprehensible, shareable,
and reusable knowledge representation that is both readable by human beings
and processible by computers.