GEM

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Element	Definition
Action	Appropriate activity to be carried out given the specific circumstances defined by values of decision variables. Store only a single action each Action element
ActionActor	The person(s) or role intended to carry out the recommended activity.
ActionBenefit	An improvement in status of some measured outcome that may occur as a result of following an action
ActionBenefitHarmAssessment	The outcome of weighing benefits against risks, harms, and costs that expresses equilibrium or imbalance for an action.
ActionCode	Identifier selected from a standard terminology that describes an action
ActionCost	Cost of performing a specific action
ActionDeonticTerm	The word of phrase that defines the level of obligation or permission of a recommendation.
ActionDescription	Text that provides and amplifies information about an action
ActionEvidenceQuality	An indication of methodologic rigor of the studies that support the specified action
ActionReason	Risk or adverse outcome associated with an action
ActionRecommendationStrength	An indication of the guideline developers' level of support for an action
ActionRiskHarm	Risk or adverse outcome associated with a specified action
ActionStep	Specifies clinical actions that are to be performed in the patient-care process (GLIF)
ActionType	A categorization of activity directed by a conditional
ActionValue	A specified state of an action

Element	Definition
ActionVerb	The word or phrase in a recommendation that expresses action, state, or relationship
ActionVerbComplement	Word or phrase that completes the sense of a verb and includes direct and indirect objects
Adaptation	Indicates that the guideline has been adapted from another guideline
Algorithm	A flowchart representation of the stages and activities in health management described by the guideline
AnticipatedBarrier	A factor that might be expected to impede operationalization of the guideline
AnticipatedEnabler	A factor that might be expected to promote operationalization of the guideline
Availability	Information regarding sources of a guideline and associated documentation
AvailableOption	Principal alternative preventive, diagnostic, or therapeutic strategies considered
BackgroundInformation	Information relevant to the guideline's topic but not related to other Knowledge Components
Benefit	An improvement in status of some measured outcome that may occur as a result of following this recommendation
BenefitHarmAssessment	The outcome of weighing benefits against risks, harms, and costs that expresses equilibrium or imbalance.
BranchStep	Directs flow in alternate directions (GLIF)
COIDisclosure	Report of potential and real conflicts of interest and how they are addressed
COIPolicy	Principles and strategies adopted by developer to address potential conflicts
CareSetting	The settings in which the guideline is intended for use

Element	Definition
Certainty	Indication of the likelihood that this recommendation will lead to specified outcomes
Citation	Bibliographic citation
CommitteeExpertise	Expertise present within the group that authored guideline
CommitteeMember	Name of member of guideline development committee
CommitteeName	Formal name of committee within developer organization responsible for developing guideline
CompanionDocument	Refers to other documents (including Technical Reports, Consumer Guidelines, Quick Reference Guidelines) produced by the guideline developer relevant to the guideline
ComparableGuideline	Another guideline on the same or similar topic
Conditional	A recommendation applicable under circumstances specified by an if-then statement. The complete text of the conditional statement should be stored in this element
ConditionalStep	Directs flow from one guideline step to another based on the evaluation of a criterion (GLIF)
ConflictOfInterest	Potential situations in which financial or other considerations may compromise, or have the appearance of compromising, a developer’s professional judgment
Contact	Person or organization to contact for additional information about a guideline
Cost	Overall cost of performing this recommendation
CostAnalysis	Describes any formal cost analysis performed

Element	Definition
DecisionVariable	A condition that must be tested to indicate the appropriateness of a conditional recommendation. Store only a single variable in each decision variable element
DecisionVariableCode	Identifier selected from a standard terminology that describes a decision variable
DecisionVariableCost	The cost of testing a decision variable
DecisionVariableDescription	Text that provides and amplifies information about a decision variable
Definition	Concise description of terminology relevant to the guideline
DescriptionEvidenceCollection	A description of methods used to collect, identify, and retrieve scientific evidence on each question on which recommendations are based, including details on computer searches (including dates) and use of personal files and bibliographies
DescriptionEvidenceCombination	Method of synthesis used to combine the scientific evidence quantitatively or otherwise
Developer
DeveloperName	Organization(s) responsible for developing the guideline
Directive	An appropriate activity for the eligible population. Store only a single activity in each Directive element
DirectiveActor	The person(s) or role intended to carry out the recommended activity.
DirectiveBenefit	An improvement in status that may occur as a result of following a directive
DirectiveBenefitHarmAssessment	The outcome of weighing benefits against risks, harms, and costs that expresses equilibrium or imbalance for this directive.
DirectiveCode	Identifier selected from a standard terminology that describes a directive
DirectiveCost	Cost of performing a specific directive

Element	Definition
DirectiveDeonticTerm	The word of phrase that defines the level of obligation or permission of a recommendation.
DirectiveDescription	Text that provides and amplifies information about a directive
DirectiveEvidenceQuality	An indication of methodologic rigor of the studies that support a directive
DirectiveReason	Risk or adverse outcome associated with a directive
DirectiveRecommendationStrength	An indication of the guideline developers' level of support for a directive
DirectiveRiskHarm	Risk or adverse outcome associated with implementation of a directive
DirectiveType	A categorization of activity directed by an imperative
DirectiveValue	The specified state of a directive
DirectiveVerb	The word or phrase in a recommendation that expresses action, state, or relationship
DirectiveVerbComplement	Word or phrase that completes the sense of a verb and includes direct and indirect objects
Disagreement	Description and explanation of any differences of opinion regarding the recommendation, including minority report
Electronic	Information regarding sources of guideline in electronic format
Eligibility	Describes population that the recommendations are intended to affect; identifies restrictions on guideline use such as within a managed care organization or geographic region
Endorser	Organization that has endorsed the guideline
EvidenceQuality	An indication of methodologic rigor of the studies that support the specified recommendation and the level of confidence in (certainty regarding) the evidence underpinning the recommendation

Element	Definition
EvidenceQualityDescription	Description of the applicability, quantity (including completeness) and consistency of the aggregate available evidence. It may include an explanation of the part played by values, opinion, theory, and clinical experience in deriving the recommendation
EvidenceQualityRatingScheme	Criteria for rating quality of evidence
EvidenceSelectionCriteria	Methods used to choose the evidence that informs guideline development, including inclusion and exclusion criteria for specific studies
EvidenceTimePeriod	Publication date of earliest and most recent evidence considered
Exception	Situations in which socially relevant factors permit an exception to be made in applying the guidelines; including home and family situation, constraints on health care delivery system
ExclusionCriterion	A criterion whose presence excludes the applicability of the recommendations
ExclusionCriterionCode	Identifier selected from a standard terminology that describes an exclusion criterion
Expiration	Time (or date) that recommendations cease to be valid
ExternalReview	Methods of eliciting peer review comments and vetting guideline draft
Flexibility	Indication of options in performing imperative
FormalAppraisal	Evaluation of the guideline draft to appraise its validity and usability (e.g., COGS), quality (e.g., AGREE) and implementability (e.g., GLIA)
Funding	Source of financial support for guideline development
GEMCutAuthor	Individual responsible for creating this version of the GEM file
GEMCutDate	Date when this version of the GEM file was created

Element	Definition
GEMCutHistory	Record of GEM file creation
GEMCutVersion	Identification details of the current instance of the GEM file
Goal	The state that a recommendation is intended to achieve, maintain, or avoid
GuidelineDocument
GuidelineLength	Number of pages in printed document
GuidelineTitle	Complete title of the guideline
HealthOutcome	The most important specific outcomes (health, economic, etc) considered in the guideline
Identity
Imperative	Recommendation directed at the entire target population without limitation. The complete text of the imperative statement should be stored in this element
ImplementationPlan
ImplementationStrategy	Specific plans for implementing the recommendations
InclusionCriterion	A criterion whose presence is necessary for the guideline recommendations to be applicable
InclusionCriterionCode	Identifier selected from a standard terminology that describes an inclusion criterion
IntendedAudience
IntentionalVagueness	An indication of the reason for deliberate underspecification of a recommendation's conditions or actions.
KnowledgeComponents
Linkage	Indicator of a relationship between this recommendation and other knowledge component(s)
Logic	Boolean operators that indicate how directives are to be combined

Element	Definition
MainFocus	Primary disease/condition, treatment/intervention, health practice, service, or technology addressed in the guideline main focus
MemberConflict	A potential source of bias (e.g., financial or intellectual) related to a panelist or potential panelist that could influence the CPG development process
MemberExpertise	Professional expertise of individual guideline committee member
MemberRole	Expected function of a committee member, e.g,, chair, epidemiologist, or implementation specialist
MethodOfDevelopment
MethodsToReachJudgment	Group judgment techniques used to reach judgment on recommendations; a description of how the developer made the transition from evidence to recommendation
NumberSourceDocuments	Number of source documents identified
Objective	General goals that implementation of the guideline is intended to bring about
PatientAndPublicInvolvement	Role of patients, advocates, consumer organizations in guideline development and review
PatientResource	A patient-oriented summary of guideline content or a resource intended to assist patients with guideline application.
PerformanceMeasure	Guideline-derived tool to measure the quality of care they provide by defining specific, measurable elements
PilotTesting	Preliminary validation testing
PredictiveValue	An indication of the probability of an outcome occurring when a particular value of the decision variable is present
Print	Information regarding sources of guideline in print format
Purpose

Element	Definition
QualifyingStatement	Important caveat relating to a major recommendation. Identifies an area of uncertainty
QuantificationHarmBenefit	Quantification of benefits or risks associated with implementation of guideline
QuickReferenceGuide	A concise document that summarizes guideline recommendations for clinicians
RatingScheme	Criteria for rating quality of evidence and/or strength of recommendation
Rationale	Reasons for developing recommendations including why the guideline was developed/needed, e.g., evidence of practice variation or inappropriate practice
Reason	An explanation or justification for a recommendation
Recommendation	Statement of appropriate practice and the conditions under which it is to be undertaken. The statement is intended to influence practitioners´ behavior and/or patient outcomes. A number or brief title for a specific recommendation should be stored in this element.
RecommendationNotes	Additional comments related to the development of the recommendation.
RecommendationStrength	An indication of the guideline developers' level of support for a given recommendation
RecommendationStrengthCode	Identifier selected from a standard terminology that describes recommendation strength
RecommendationStrengthRatingScheme	Criteria for rating strength of recommendation
Reference	Specific citation relevant to this imperative recommendation
ReleaseDate	Date on which the guideline was released to the public
ResearchAgenda	Proposal for further scientific investigation to correct identified deficiencies in the evidence base for this guideline topic

Element	Definition
RevisionPlan
RiskHarm	Risk or adverse outcome associated with this recommendation
RoleOfSponsor	The sponsor's part in developing, modifying, and reporting the guideline
RolePatientPreference	Role of patient preferences for possible outcomes of care when the appropriateness of a clinical intervention involves a substantial element of personal choice or values
RoleValueJudgment	Implicit or explicit process for judging relative desirability of health, economic, and process outcomes associated with alternative practices
ScheduledReview	Future time (or date) planned to review continued appropriateness of recommendations
Scope	Implicit eligibility criteria for an imperative statement
ScopeCode	Identifier selected from a standard terminology that describes the scope
Sensitivity	An indication of the probability of the decision variable being present under specific clinical circumstances
SpecificationHarmBenefit	Qualitative description of anticipated benefits and potential risks associated with implementation of guideline
Specificity	An indication of the probability of the decision variable being absent under specific clinical circumstances
StatementOfFact	A non-executable statement intended by the author to describe appropriate care. This category includes US Preventive Services Task Force "I Statements", i.e., the authors conclude that there is insufficient evidence to support a recommendation for or against such an action
Status	Statement of whether the guideline is original or a revised or updated version of a previously issued document

Element	Definition
StructuredAbstract	A summary statement that describes a guideline using structured headings
SynchronizationStep	Synchronization Step represents a convergence of other steps (GLIF)
TargetPopulation
TechnicalReport	A document or document component that describes in detail the method of guideline development
Term	A word or phrase defined in the guideline
TermMeaning	Precise meaning of words and phrases that may be unfamiliar to guideline readers; terms are defined as used in this guideline context
TestParameter	Information about the quality of a decision variable
Testing
Users	Intended users of guideline information
Value	A specified state of a decision variable

GEM III ATTRIBUTES

Attribute	Definition
action.id	Unique identifier for a guideline-prescribed action
codeset	Name of the dataset of concept identifiers
decision.variable.id	Unique identifier for a guideline-specified condition
directive.id	Unique identifier for a guideline-prescribed directive
id	Unique identifier
lang	Language in which a guideline is published
source	Indicates whether text is extracted verbatim or is inferred by the guideline encoder
version	Refers to a particular instance of an element

Last modified: 3/14/2013