Clinical Practice Guidelines (CPGs) are at the core of evidence-based medicine. They are also massive documents, often cumbersome to use and difficult to search. But a new mobile app from the AAOS is changing all that.

To access the app, simply go to OrthoGuidelines.org; the new web-based platform will recognize the type of device being used (smart phone, tablet, or desktop computer) and display in the most appropriate format (Figs. 1A, B). Users will be able to access all AAOS CPG recommendations, conduct key word searches, and sort recommendations by topic, stage of care, or recommendation strength.

OrthoGuidelines.org is available to clinicians, patients, and the public; no log-in is necessary to access the website or mobile application.

The new, interactive presentation revolutionizes how CPGs are disseminated, making their use more efficient and their implementation more practical.

The use of responsive design technology means that the cleanest version of the information will be presented, whether it’s viewed on a phone, tablet, or desktop computer. This makes OrthoGuidelines easy to reference and navigate from a mobile phone in an active environment, or from a computer for a more in-depth experience.

Seamless access
OrthoGuidelines brings all AAOS CPGs under one technological roof, enhancing access with a flexibility not previously available. Users can now reference specific recommendations or cross-reference between guidelines on a single page. In addition, OrthoGuidelines provides seamless access to the AAOS appropriate use criteria (AUC) app, enabling clinicians to check the CPG and move to a patient scenario to verify the appropriateness of a particular treatment (or vice versa) with a couple of clicks.

Features
OrthoGuidelines shows a guideline’s topics, strengths, and its parent CPG, without the user’s needing to view the full list of recommendation first. The platform also features a keyword search function that spans all AAOS-published CPGs simultaneously. Users see a list of relevant recommendations, along with their respective strengths and CPG topics, resulting in a comprehensive approach to all AAOS CPGs.

The advanced search function examines the most relevant fields for keywords, reducing the number of irrelevant search results. Relevant recommendations are presented in a format that is easy to digest and interpret. Users can also sort recommendations by guideline topic (such as osteoarthritis of the knee), stage of care (such as preventive, screening, diagnostic, nonsurgical, surgical, postoperative, or rehabilitation), or recommendation strength (strong, moderate, limited, consensus, or inconclusive).

With these options, users can quickly access all recommendations that pertain to a certain specialty or that may be most relevant for a particular patient. All results are sorted by the parent CPG to eliminate confusion.

A full rationale accompanies each recommendation, giving users a more in-depth explanation, context, and description of the evidence that supports it. Each recommendation also has all relevant references listed for a more thorough and transparent experience. References are linked to PubMed, as available, providing immediate access to the study abstract. Users interested in examining the data summaries and evidence tables can still reference the full guidelines through a direct link from each recommendation.

Case studies and CME
To illustrate the practical application of evidence, OrthoGuidelines also presents case studies for most of the published CPGs. Each case study has an interactive quiz to provide self-study opportunities.

Case studies are accessible via a link on the main page of each CPG as well as from the header of the desktop site under “Guidelines” or directly from the footer of the mobile site.

OrthoGuidelines also features a robust education section that contains evidence-based webinars and CME courses designed and maintained by AAOS volunteers and staff. All video-based presentations are designed to play smoothly on both mobile device and desktop formats. CME credit courses designed for evidence-based medicine are presented in their entirety; future developments will allow users to earn CME credit directly from the web-app. Currently, users may view the courses from the OrthoGuidelines app, but will need to go to the AAOS website to obtain the CME credit.

OrthoGuidelines.org also provides direct access to the Academy’s AUC tool (www.orthoguidelines.org/auc). These AUCs enable users to enter a patient indication profile based on some easily distinguishable options, generating treatment appropriateness ratings that are in accordance with published literature and applied physician expertise.

Try it today
AAOS members are encouraged to try OrthoGuidelines for themselves. Although the app was pilot-tested with residents during its development, it will be continuously updated with new content—and comments from users are welcome.

Additional information on evidence-based medicine and AAOS quality initiatives can be found at www.aaos.org/research

Any questions or comments regarding OrthoGuidelines.org or the Agency for Healthcare Research and Quality (AHRQ) grant can be directed to Kaitlyn Sevarino, evidence-based quality and value coordinator, at sevarino@aaos.org

Kaitlyn Sevarino is the evidence-based quality and value coordinator, and Ryan Pezold, MA, is a research analyst in the AAOS department of research and quality.

Grant Made OrthoGuidelines App a Reality
When the Agency for Healthcare Research and Quality (AHRQ) announced the availability of 3-year innovation grants, the AAOS saw an opportunity to turn clinical practice guidelines (CPGs) into interactive documents. The increasing use of smart phones, tablets, and desktop computers provided electronic platforms for accessing CPGs in the exam room, the emergency department, and the surgical suite.

Awarded in June 2013 (See “AAOS Wins AHRQ Grant,” AAOS Now, July 2013), the grant covered the creation, pilot testing, and dissemination of a new electronic platform to transform CPGs into interactive documents. Kevin J. Bozic, MD, MBA, chair of the AAOS Council on Research and Quality, served as project director, and Deborah S. Cummins, PhD, director of the AAOS research and scientific affairs department, was the project investigator. The platform was created in 2013 and pilot tested with five U.S. residency programs in 2014. Resident feedback from the pilot tests was used to improve the platform, and data were collected on CPG usage. The results from this study will be published following completion of the multiyear grant (March 2016).