Guideline-based quality indicators—a systematic comparison of German and international clinical practice guidelines

Abstract

Background Evidence-based clinical practice guidelines (CPGs) are relevant sources for generating quality indicators (QIs). The objective of this study was to compare guideline-based QIs of German and international CPGs and their underlying methodological approaches. Methods We conducted systematic searches in the guideline databases of G-I-N (Guidelines International Network) and NGC (National Guideline Clearinghouse) between February and June 2017 to identify international CPGs matching the topics of German evidence-based CPGs ( n = 35) that report QIs, which were identified in a preceding study. Additionally, we searched the websites of the particular CPG providers for separate documents with regard to QIs. We included evidence-based CPGs which report QIs. Reported QIs, the underlying guideline recommendations, and information on methods of development were extracted. The selection and extraction of CPGs were conducted by one reviewer and checked by another. For each matched pair of CPGs, we assessed whether the suggested QIs matched or were not directly comparable. Results Twenty-five international CPGs, originating from seven CPG providers in total, met the criteria for inclusion. They matched the topics of 18 German CPGs. This resulted in 30 CPG pairs for the comparison of QIs (some of the international CPGs matched the topic of more than one German CPG). We found 27 QI pairs with QIs “not different or slightly different”, corresponding to 13% (27 of 212) of the QIs in German CPGs and 16% (27 of 166) in international CPGs. Only two QI pairs were judged to be “different/inconsistent”. For 183 of 212 (86%) QIs from German CPGs and 137 of 166 (83%) QIs from international CPGs, no direct comparison could be made. An explicit link to one or more guideline recommendations was found for 136 of 152 (89%) QIs from German CPGs and 82 of 166 (49%) QIs from international CPGs. Some information on methods for the development of QIs existed for 12 of 18 (67%) German CPGs and 8 of 25 (32%) international CPGs. Conclusions The majority of QIs in German and international CPGs were not comparable. Various reasons for this are conceivable. More transparent reporting of the underlying methods for generating guideline-based QIs is needed. Electronic supplementary material The online version of this article (10.1186/s13012-019-0918-y) contains supplementary material, which is available to authorized users.

International experiences in the development and implementation of guideline-based quality indicators: a qualitative study

“… 7 The latter was still found by Becker et al . 12 Our results suggest that methodological weaknesses in QI development may still be due to a lack of knowledge and expertise and limited financial resources.…”

“…Potential participants from 8 organisations of the 11 identified by Becker et al 12 were initially contacted, three did not respond. For each non-responder, an alternative organisation was identified and could be recruited.…”

“…de/ gepris/ projekt/ 289625106), 9 we here report an international qualitative study. Further subprojects included an analysis of existing German guideline-based QI, 10 qualitative interviews with German authors from guidelines with and without development of guideline-based QI, 11 a comparison of international and German guideline-based QI published on the same topic 12 and a systematic compilation of existing assessment instruments for QI. The results of this study will be shared within the respective G-I-N working group with the aim to contribute to an international methodological standard.…”

Selecting home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC) for Switzerland: A public health and healthcare providers' perspective

“…To fulfill their purpose, process measures need to be based on strong clinical evidence showing positive associations between implementation of state-of-the-art care processes and clinical outcomes (process-outcome link). Ideally, process QIs are generated from evidence-based clinical practice guidelines [ 17 , 57 , 58 ]. Many such practice guidelines exist [ 59 , 60 ], but are not necessarily developed for home care.…”

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“…To fulfill their purpose, process measures need to be based on strong clinical evidence showing positive associations between implementation of state-of-the-art care processes and clinical outcomes (process-outcome link). Ideally, process QIs are generated from evidencebased clinical practice guidelines [17,57,58]. Many such practice guidelines exist [59,60], but are not necessarily developed for home care.…”