Schmitt Jochen, Petzold Thomas, Eberlein-Gonska Maria, Neugebauer Edmund A M
Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden.
Z Evid Fortbild Qual Gesundhwes. 2013;107(8):516-22. doi: 10.1016/j.zefq.2013.09.014. Epub 2013 Nov 4.
The assessment of the health state in patients and changes in their health state for the purpose of diagnosis, prognosis and monitoring of treatment response plays a central role in clinical practice. Quality criteria for measurements in medicine include validity, reliability, responsiveness, interpretability, and feasibility. High-quality measurement instruments are a prerequisite for evidence-based medicine. Therefore, international outcomes research groups have developed methods for quality assurance and for the standardisation of measurement instruments. Quality indicators are instruments to measure the quality of care. Due to the increasing relevance of quality assessment for all stakeholders in healthcare and due to the political intention to draw relevant conclusions from the assessment of the quality of care, quality indicators must at least meet the same high standards that are required for clinical trial end points. However, independent researchers and clinicians do not engage in the validation and standardisation of quality indicators in Germany; currently, only the AQUA institute (as assigned by the German GBA) deals with this important issue. Current activities concerning the validation of quality indicators do not meet the requirements of evidence-based healthcare. This is a critical barrier to achieving the political goals of quality medicine. Therefore, the authors propose a multi-step, multi-professional, evidence-driven and evidence-generating consensus process on the basis of established methods of outcomes research for the advancement of quality assessment with quality indicators in Germany. All relevant stakeholders should participate in this process.
对患者健康状况的评估以及其健康状况的变化，以用于诊断、预后和治疗反应监测，在临床实践中起着核心作用。医学测量的质量标准包括有效性、可靠性、反应性、可解释性和可行性。高质量的测量工具是循证医学的先决条件。因此，国际结果研究小组已开发出质量保证方法和测量工具标准化方法。质量指标是衡量医疗质量的工具。由于医疗保健中所有利益相关者对质量评估的相关性日益增加，且出于从医疗质量评估中得出相关结论的政治意图，质量指标必须至少达到与临床试验终点相同的高标准。然而，在德国，独立研究人员和临床医生并不参与质量指标的验证和标准化工作；目前，只有AQUA研究所（由德国联邦联合委员会指定）处理这一重要问题。当前有关质量指标验证的活动不符合循证医疗保健的要求。这是实现优质医疗政治目标的一个关键障碍。因此，作者基于已确立的结果研究方法，提出一个多步骤、多专业、循证驱动和循证生成的共识过程，以推动德国利用质量指标进行质量评估。所有相关利益相关者都应参与这一过程。
