Kopp I, Encke A, Lorenz W
Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) und Institut für Theoretische Chirurgie, Philipps-Universität Marburg, Germany.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2002 Mar;45(3):223-33. doi: 10.1007/s00103-002-0378-3.
The Association of the Scientific Medical Societies in Germany (AWMF) established a national guideline-programme respecting the specific conditions of the German health-care system as well as fulfilling the demands of clinical research. It consists of a three-level concept for guideline development and an implementation system. The three-level concept assumes a continuous process of development and quality improvement of guidelines. At level three, guidelines have to fulfill five criteria of systematic development: consensus (presupposed application of formal techniques and participation of all relevant stakeholders), logical analysis (clinical algorithms), evidence (based on best available evidence derived from comprehensive, systematic reviews and linking all recommendations explicitly to the evidence), decision analysis and outcome analysis (using epidemiologic, effectiveness, pharmacologic, psychometric, economic studies and qualitative methods for identifying the true endpoint). The implementation system is based on four components: definite guideline groups within the scientific societies, conceptualised quality improvement of guidelines, continuous medical education and systematic evaluation. The establishment of this system has induced a change: the process of developing top-level guidelines has become uniform and there is a strong trend towards quality improvement. 75 evidence- and consensus- based guidelines (level two and three) have already been published. The scientific medical societies have indicated their motivation to continue the program by formulating 75 prior conditions for which top-level guidelines shall be developed in the near future.
德国科学医学协会（AWMF）制定了一项国家指南计划，该计划既考虑到德国医疗保健系统的具体情况，又满足临床研究的要求。它由指南制定的三级概念和一个实施系统组成。三级概念假定了一个指南持续发展和质量改进的过程。在第三级，指南必须满足系统开发的五个标准：共识（假定应用正式技术并让所有相关利益攸关方参与）、逻辑分析（临床算法）、证据（基于全面、系统综述得出的最佳现有证据，并将所有建议明确与证据相联系）、决策分析和结果分析（使用流行病学、有效性、药理学、心理测量学、经济学研究以及定性方法来确定真正的终点）。实施系统基于四个组成部分：科学协会内部明确的指南小组、概念化的指南质量改进、持续医学教育和系统评估。这个系统的建立引发了一种变化：顶级指南的制定过程变得统一，并且有很强的质量改进趋势。已经发布了75份基于证据和共识的指南（二级和三级）。科学医学协会已表明他们有动力通过制定75项先决条件来继续该计划，在不久的将来将针对这些条件制定顶级指南。
