First a description of the three caremap evaluation scoring elements: Cluzeau, Evidence, Overall, and Reliability.

The Cluzeau score is generated from the Appraisal Instrument for Clinical Guidelines (Cluzeau et. al, 1997). This tool was developed to provide a structured approach to guideline appraisal. The instrument consists of 37 questions addressing three dimensions: Rigour of Development, Context and Content and Application.

Our Cluzeau Score is the sum of the "condition is present" ratings and the highest possible score is 37.

Our evidence rating indicates the research base underlying the caremap, in which
1 = a concensus caremap,
2 = non-randomized cohort studies, observational trials, or pre/post studies
3 = controlled trials
4 = randomized control trials (RCT's), or systematic reviews/meta-analyses of RCT's.

The overall score combines the Cluzeau and Evidence ratings:
If cluzeau & evidence are both present: score = (((cluzeau ÷ 37) + (evidence ÷ 4)) ÷ 2) × 100
If just cluzeau is present: score = (cluzeau ÷ 37) × 100
If just evidence is present: score = (evidence ÷ 4) × 100
In plain English: the score is a percent, and if both are present they are averaged.

The reliability score indicates the correlation between the ratings of two raters.

Finding and evaluating the materials

Step 1: The process began with the convening of an interdisciplinary innovations team of health professionals with both hospital and home care experience

Step 2: The substantive domain of interest, search time frame (January 1990 to January 2002)and the appropriate databases (Medline, CINHALL, EMBASE) for the for search were identified along with a telephone and internet assisted search for unpublished caremaps.

Step 3: The development of search strings and initial data gathering.

Step 4: Each abstract was reviewed by two team members to assess likely relevance. If both reviewers agreed then the article was "pulled" for evaluation. If the reviewers disagreed, the abstract was reviewed by the team and a final decision was made to "pull" the article for detailed review.

Step 5: A further refinement of the pulled articles to include only those articles in which a care-map algorithm, decision tree or checklist was presented and confirmation of the presence of seniors in the caremap development process.

Step 6: Each of the published caremaps meeting the the two preliminary reviews were rated by two independent raters using the Cluzeau and evidence rating instruments.

Step 7: The database and website was constructed

Step 8: A usability walkthrough was completed and the website was revised and released.

Future Steps: We have lots more to do. Right now the utility simply speeds up the process of finding the references for published caremaps. Gradually, we will add abstracts of the articles and seek permissions to provide copies/graphics of these caremaps. We also have many unpublished caremaps to review and we will develop our capacity to provide a caremap review and listing service.