Empfehlungen zur Messung der Versorgungsqualität in aktuellen S3-Leitlinien: Eine kritische Bestandsaufnahme

Abstract

Despite the increasing relevance of quality assessment for all stakeholders in the German healthcare system only approximately 40% of the S3 guidelines define indicators to measure the quality of care. Recommendations to assess outcome indicators are only provided in 10% of S3 guidelines. The process of the development and recommendation of quality indicators is heterogeneous and frequently not transparently reported. The current practice for the recommendation and validation of quality indicators in German S3 guidelines does not meet the requirements of evidence-based healthcare.

Quality Measurement Recommendations Relevant to Clinical Guidelines in Germany and the United Kingdom: (What) Can We Learn From Each Other?

“…The definition and dissemination of quality indicators relevant to CGs occurs both in Germany and NICE. 20 - 24 The recommended methodology of the derivation of quality indicators differed between Germany and NICE.…”

“…However, such information on quality indicators is crucial for their implementation in routine care and a necessary prerequisite to obtain resilient and convincing results. 20 , 40 Therefore, a standardized method appears necessary in both countries for the implementation of these requirements.…”

“…We undertook a systematic review on all German S3 guidelines (effective November 30, 2013) 20 and all NICE CGs (effective April 1, 2014). The relevant literature was independently searched and assessed by 2 reviewers, and relevant information concerning quality indicators was extracted in a standardized manner.…”

Guideline-based quality indicators—a systematic comparison of German and international clinical practice guidelines: protocol for a systematic review

“…A standardized extraction form will be developed based on the data extraction items used in a preliminary project [ 15 ] and pilot-tested. The following information will be collected: Information on QI-development group (number of members and positions, such as methodologists, clinicians, patient representatives) Labeling of the measure of quality, e.g., QI, quality criteria, performance measure Categorization of QI in structure, process, outcome indicator according to the definition of Donabedian [ 22 ] (in case of missing assignment by the guideline authors an own assignment will be made) Underlying recommendations, if the QIs are based explicitly or implicitly on those Reported rationale for the QI Reported measurement properties of QI, e.g., reliability and validity [ 23 ] Reported intended purpose of QI, e.g., quality reporting, quality management systems, evaluation of CPGs Reported quality objectives Methods of QI-development, e.g., searches for existing QIs, consensus methods, assessment-tools …”

“…S3-CPGs comprise both the requirements for S2k-CPGs and those for S2e-CPGs and thus have the highest methodological standard in Germany. An analysis of the status quo of reported QIs in S3-CPGs from 2013 found 34 S3-CPGs, which report 394 different QIs (including measures of quality which are labeled such as “quality criteria” or “quality measure”) [ 15 ]. For example, the S3-CPG “Diagnostics, treatment and follow-up care of malignant ovarial tumors” comprises 12 QIs, one of them regarding counseling by a social service (numerator: number of patients with counseling by a social service; denominator: all patients with an initial diagnosis of ovarian cancer and treatment in a clinical institution) [ 16 ].…”