Nothacker Monika Judith, Langer Thomas, Weinbrenner Susanne
Ärztliches Zentrum für Qualität in der Medizin, Bereich Evidenzbasierte Medizin und Leitlinien, Berlin.
Z Evid Fortbild Qual Gesundhwes. 2011;105(1):27-37. doi: 10.1016/j.zefq.2010.07.003.
Together with an expert committee a structured approach to determining quality indicators for National Disease Management Guidelines has been developed. The key steps of this approach include: introducing guideline authors to the methodology at an early stage of the process of guideline development, pre-selecting recommendations of the guideline which are potentially measurable by means of quality indicators, assessing the potentially measurable quality indicators in written form using five criteria (including their importance for the health care system and clarity of definitions) and approving them in a formal consensus process. For lack of a database these quality indicators must be regarded as preliminary. For the National Disease Management Guideline "Chronic Heart Failure" nine rate-based indicators have been chosen. The indicators correspond to important strong recommendations (grade of recommendation: A) from the fields of diagnosis (two), general therapeutic strategy (two), specific treatment (three), clinical monitoring (one) and co-ordination of care (one). In a second step, the quality indicators have to be validated within a pilot project. The determination and assessment of the potential quality indicators have revealed room for improvement of guideline development. In particular, there is a need for more health care data and for specification of recommendations.
与一个专家委员会共同制定了一种用于确定国家疾病管理指南质量指标的结构化方法。该方法的关键步骤包括：在指南制定过程的早期阶段向指南作者介绍该方法，预先选择指南中可通过质量指标进行潜在衡量的建议，使用五个标准（包括其对医疗保健系统的重要性和定义的清晰度）以书面形式评估潜在可衡量的质量指标，并在正式的共识过程中批准这些指标。由于缺乏数据库，这些质量指标必须被视为初步的。对于国家疾病管理指南“慢性心力衰竭”，已选择了九个基于比率的指标。这些指标对应于诊断（两个）、一般治疗策略（两个）、特定治疗（三个）、临床监测（一个）和护理协调（一个）领域的重要强烈推荐（推荐等级：A）。第二步，质量指标必须在一个试点项目中进行验证。潜在质量指标的确定和评估揭示了指南制定方面仍有改进空间。特别是，需要更多的医疗保健数据以及对建议进行细化。
