Institute for Medical Knowledge Management c/o Philipps University Marburg, Association of the Scientific Medical Societies in Germany, Marburg/Berlin, Germany
Institute for Medical Knowledge Management c/o Philipps University Marburg, Association of the Scientific Medical Societies in Germany, Marburg/Berlin, Germany.
BMJ Open. 2021 Jan 19;11(1):e039770. doi: 10.1136/bmjopen-2020-039770.
Evidence-based clinical guidelines play an important role in healthcare and can be a valuable source for quality indicators (QIs). However, the link between guidelines and QI is often neglected and methodological standards for the development of guideline-based QI are still lacking. The aim of this qualitative study was to get insights into experiences of international authors with developing and implementing guideline-based QI.
We conducted semistructured interviews via phone or skype (September 2017-February 2018) with guideline authors developing guideline-based QI.
15 interview participants from eight organisations in six European and North American countries.
Organisations were selected using purposive sampling with a maximum variation of healthcare settings. From each organisation a clinician and a methodologist were asked to participate. An interview guide was developed based on the QI development steps according to the 'Reporting standards for guideline-based performance measures' by the Guidelines International Network. Interviews were analysed using qualitative content analysis with deductive and inductive categories.
Interviewees deemed a programmatic approach, involvement of representative stakeholders with clinical and methodological knowledge and the connection to existing quality improvement strategies important factors for developing QI parallel to or after guideline development. Methodological training of the developing team and a shared understanding of the QI purpose were further seen conducive. Patient participation and direct patient relevance were inconsistently considered important, whereas a strong evidence base was seen essential. To assess measurement characteristics interviewees favoured piloting, but often missed implementation. Lack of measurability is still experienced a serious limitation, especially for qualitative aspects and individualised care.
Our results suggest that developing guideline-based QI can succeed either parallel to or following the guideline process with careful planning and instruction. Strategic partnerships seem key for implementation. Patient participation and relevance, measurement of qualitative aspects and piloting are areas for further development.
German Clinical Trials Registry (DRKS00013006).
循证临床指南在医疗保健中发挥着重要作用，是质量指标（QIs）的宝贵来源。然而，指南与 QI 之间的联系常常被忽视，并且基于指南的 QI 开发的方法学标准仍然缺乏。本定性研究的目的是深入了解国际作者在制定和实施基于指南的 QI 方面的经验。
我们通过电话或 Skype（2017 年 9 月至 2018 年 2 月）对半结构化访谈进行了采访，采访对象是参与制定基于指南的 QI 的指南作者。
来自欧洲和北美六个国家的八个组织的 15 名访谈参与者。
使用具有最大变化的医疗保健环境的目的抽样选择组织。从每个组织中邀请一名临床医生和一名方法学家参与。根据指南国际网络的“基于指南的绩效措施报告标准”，根据 QI 开发步骤制定了访谈指南。使用定性内容分析对访谈进行分析，采用演绎和归纳类别。
受访者认为，一种计划方法、有临床和方法知识的代表性利益相关者的参与以及与现有质量改进策略的联系是平行于或在指南开发之后开发 QI 的重要因素。开发团队的方法学培训以及对 QI 目的的共同理解也被认为是有利的。患者参与和直接的患者相关性被认为是不一致的重要因素，而强有力的证据基础被认为是必不可少的。为了评估测量特征，受访者倾向于试点，但经常错过实施。缺乏可衡量性仍然是一个严重的限制，特别是对于定性方面和个体化护理。
我们的结果表明，基于指南的 QI 的开发可以通过仔细的规划和指导，与指南过程平行或在其之后成功进行。战略伙伴关系似乎是实施的关键。患者参与和相关性、定性方面的测量和试点是进一步发展的领域。
德国临床试验注册处（DRKS00013006）。
