背景:基于证据和正式共识的临床实践指南(S3-CPG)是德国质量指标(QI)开发的宝贵来源。虽然从指南建议中得出QI是国家疾病管理指南(DMGP)和德国肿瘤学指南(GGPO)中S3-CPG开发的强制性部分,德国科学医学会协会(AWMF)(MS计划)的指南计划中没有此类义务。尽管如此,在过去几年中,MS计划中的几个S3-CPG已与QI一起发布,而一些DMGP和一个GGPOS3指南未能满足此要求。从所有提到的三个程序的指南作者的角度来看,本定性研究调查了S3-CPG为何包含或不包含QI,并探讨了作者认为促进或阻碍QI开发过程的因素.
方法:对22个S3-CPG的作者进行了半结构化访谈,其中11个代表包含QIs的准则,其中11个代表不包含QIs的准则。向包含QI(n=11)的指南的作者询问了制定QI的决定性原因以及QI开发过程中的促进者和障碍。没有QIs的指南的作者(n=11)给出了不制定QIs的原因。使用结构化定性内容分析对访谈进行了分析。
结果:在MS程序中,没有制定质量指数主要归因于缺乏强制性要求和指南项目资金不足。在DMGP作者中,QI发展的低优先级盛行,那是,例如,由于已经存在的QI或缺乏实施。在所审查的GGPO指南中,没有制定QIs是由于指南主题(预防)-对于这个主题,缺乏适当的证据和数据来源。如果开发了QIs,发展过程中最重要的促进因素,在所有项目中,是指南计划提供的方法学支持。重要的阻碍因素包括QI开发所需的额外时间以及对许多潜在QI实施的担忧,特别是由于缺乏数据可用性。
结论:对于在S3-CPG项目中定期开发QI,将这样的要求纳入指南计划是必要的,但还不够,condition.其他关键因素包括系统的方法论支持,充足的财政和人力资源,以及基于指南的QI开发的感知意义和相关性,根据现有QI的实际执行情况进行衡量。
结论:该研究揭示了在德国S3-CPG项目中加强对QI发展考虑的措施的起点,特别是在MS程序中。如果没有实质性的结构变化,特别是准则组的资源,没有涵盖从QI开发到QI实施的整个过程的整体概念,基于指南的QI开发仍将严重依赖于指南组的(自我)动机。
BACKGROUND: Evidence-based and formally
consensus-based clinical practice
guidelines (S3-CPGs) are a valuable source for the development of quality indicators (QIs) in Germany. While deriving QIs from guideline recommendations is a mandatory part of the development of S3-CPGs within the National Program for Disease Management
Guidelines (DMGP) and the German
Guideline Program in Oncology (GGPO), there is no such obligation in the guideline program of the Association of the Scientific Medical Societies in Germany (AWMF) (MS program). Despite that, several S3-CPGs in the MS program have been published with QIs in the last years while some DMGP and one GGPO S3 guidelines have failed to meet this requirement. From the perspective of the guideline authors of all three mentioned programs, the present qualitative study examined why S3-CPGs do or do not contain QIs and explored the factors perceived by authors as either facilitating or hampering in the QI development process.
METHODS: Semi-structured interviews were conducted with authors of 22 S3-CPGs, 11 of which represented guidelines containing QIs and 11 of which represented
guidelines without QIs. Authors of guidelines containing QIs (n=11) were asked about the perceived decisive reasons for formulating QIs and about facilitators and barriers during the QI development process. Authors of
guidelines without QIs (n=11) gave reasons for not formulating QIs. Interviews were analyzed using structuring qualitative content analysis.
RESULTS: Within the MS program, not formulating QIs was mainly attributed to the lack of a mandatory requirement and to insufficient funding of guideline projects. Amongst DMGP authors, a low priority of QI development prevailed, which was, for example, due to already existing QIs or to their lacking implementation. In the GGPO
guideline examined, not formulating QIs was due to the
guideline topic (prevention) - for this topic, there was a lack of suitable evidence and data sources. If QIs were developed, the most important facilitating factor in the development process, across all programs, was the methodological support provided by the guideline program. Important hampering factors included the additional time required for QI development and concerns regarding the implementation of many potential QIs, especially due to a lack of data availability.
CONCLUSIONS: For regular development of QIs within S3-CPG projects, the incorporation of such a requirement in the guideline program is a necessary, but not a sufficient, condition. Other pivotal factors include systematic methodological support, adequate financial and staff resources and the perceived meaningfulness and relevance of guideline-based QI development, measured in terms of the actual implementation of already existing QIs.
CONCLUSIONS: The study reveals starting points for measures to strengthen the consideration of QI development in German S3-CPG projects, especially within the MS program. Without substantial structural changes, especially of the resources of guideline groups, and without an overall concept covering the entire process from QI development to QI implementation, guideline-based QI development will remain heavily dependent on the (self-)motivation of guideline groups.