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Methods for the guideline-based development of quality indicators--a systematic review.

Kötter T, Blozik E, Scherer M - Implement Sci (2012)

Bottom Line: Two researchers selected publications reporting methodological approaches to guideline-based QI development.Further research is needed to determine which elements of the methodological approaches identified, described, and compared in this review are best suited to constitute a gold standard for guideline-based QI development.For this research, we provide a comprehensive groundwork.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. t.koetter@uke.de

ABSTRACT

Background: Quality indicators (QIs) are used in many healthcare settings to measure, compare, and improve quality of care. For the efficient development of high-quality QIs, rigorous, approved, and evidence-based development methods are needed. Clinical practice guidelines are a suitable source to derive QIs from, but no gold standard for guideline-based QI development exists. This review aims to identify, describe, and compare methodological approaches to guideline-based QI development.

Methods: We systematically searched medical literature databases (Medline, EMBASE, and CINAHL) and grey literature. Two researchers selected publications reporting methodological approaches to guideline-based QI development. In order to describe and compare methodological approaches used in these publications, we extracted detailed information on common steps of guideline-based QI development (topic selection, guideline selection, extraction of recommendations, QI selection, practice test, and implementation) to predesigned extraction tables.

Results: From 8,697 hits in the database search and several grey literature documents, we selected 48 relevant references. The studies were of heterogeneous type and quality. We found no randomized controlled trial or other studies comparing the ability of different methodological approaches to guideline-based development to generate high-quality QIs. The relevant publications featured a wide variety of methodological approaches to guideline-based QI development, especially regarding guideline selection and extraction of recommendations. Only a few studies reported patient involvement.

Conclusions: Further research is needed to determine which elements of the methodological approaches identified, described, and compared in this review are best suited to constitute a gold standard for guideline-based QI development. For this research, we provide a comprehensive groundwork.

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Overview of the process of guideline-based QI development.
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Figure 2: Overview of the process of guideline-based QI development.

Mentions: Two researchers independently extracted data from the relevant literature to a predesigned data extraction form (see Additional file 3: Table S3); discrepancies were solved by consensus. In order to describe and to compare methodological approaches to guideline-based QI development, we developed an a priori framework of the QI development process. For this purpose, we identified six steps that most methodological approaches to guideline-based QI development have in common with regard to function and succession but that differ in their design from one methodological approach to another. Through a preliminary search and analysis of a select number of key publications, we identified six development steps: (1) topic selection, (2) guideline selection, (3) extraction of recommendations, (4) QI selection, (5) practice test, and (6) implementation (see Figure 2). The data extraction form was specifically designed to include (a) information about the methodological approach to these six development steps and (b) items necessary to perform a quality assessment of the relevant studies. For steps 1 to 4, we extracted information about how and by whom the specific development step was conducted, such as selection criteria for topics, guidelines, and recommendations, as well as participants. The two development steps specific to guideline-based QI development (compared to QI development from other sources) were investigated in more detail, namely, guideline selection and extraction of recommendations. In addition to the above-mentioned selection criteria, we collected information about the selected guidelines (Was some sort of quality assessment conducted? Were all selected guidelines listed in the publication?), as well as the extracted recommendations (Were they reported at all? If yes, were the source guideline and the underlying level of evidence made transparent?). For an overview of all selected information on guideline selection and extraction of recommendations, see Table 1.


Methods for the guideline-based development of quality indicators--a systematic review.

Kötter T, Blozik E, Scherer M - Implement Sci (2012)

Overview of the process of guideline-based QI development.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3368783&req=5

Figure 2: Overview of the process of guideline-based QI development.
Mentions: Two researchers independently extracted data from the relevant literature to a predesigned data extraction form (see Additional file 3: Table S3); discrepancies were solved by consensus. In order to describe and to compare methodological approaches to guideline-based QI development, we developed an a priori framework of the QI development process. For this purpose, we identified six steps that most methodological approaches to guideline-based QI development have in common with regard to function and succession but that differ in their design from one methodological approach to another. Through a preliminary search and analysis of a select number of key publications, we identified six development steps: (1) topic selection, (2) guideline selection, (3) extraction of recommendations, (4) QI selection, (5) practice test, and (6) implementation (see Figure 2). The data extraction form was specifically designed to include (a) information about the methodological approach to these six development steps and (b) items necessary to perform a quality assessment of the relevant studies. For steps 1 to 4, we extracted information about how and by whom the specific development step was conducted, such as selection criteria for topics, guidelines, and recommendations, as well as participants. The two development steps specific to guideline-based QI development (compared to QI development from other sources) were investigated in more detail, namely, guideline selection and extraction of recommendations. In addition to the above-mentioned selection criteria, we collected information about the selected guidelines (Was some sort of quality assessment conducted? Were all selected guidelines listed in the publication?), as well as the extracted recommendations (Were they reported at all? If yes, were the source guideline and the underlying level of evidence made transparent?). For an overview of all selected information on guideline selection and extraction of recommendations, see Table 1.

Bottom Line: Two researchers selected publications reporting methodological approaches to guideline-based QI development.Further research is needed to determine which elements of the methodological approaches identified, described, and compared in this review are best suited to constitute a gold standard for guideline-based QI development.For this research, we provide a comprehensive groundwork.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. t.koetter@uke.de

ABSTRACT

Background: Quality indicators (QIs) are used in many healthcare settings to measure, compare, and improve quality of care. For the efficient development of high-quality QIs, rigorous, approved, and evidence-based development methods are needed. Clinical practice guidelines are a suitable source to derive QIs from, but no gold standard for guideline-based QI development exists. This review aims to identify, describe, and compare methodological approaches to guideline-based QI development.

Methods: We systematically searched medical literature databases (Medline, EMBASE, and CINAHL) and grey literature. Two researchers selected publications reporting methodological approaches to guideline-based QI development. In order to describe and compare methodological approaches used in these publications, we extracted detailed information on common steps of guideline-based QI development (topic selection, guideline selection, extraction of recommendations, QI selection, practice test, and implementation) to predesigned extraction tables.

Results: From 8,697 hits in the database search and several grey literature documents, we selected 48 relevant references. The studies were of heterogeneous type and quality. We found no randomized controlled trial or other studies comparing the ability of different methodological approaches to guideline-based development to generate high-quality QIs. The relevant publications featured a wide variety of methodological approaches to guideline-based QI development, especially regarding guideline selection and extraction of recommendations. Only a few studies reported patient involvement.

Conclusions: Further research is needed to determine which elements of the methodological approaches identified, described, and compared in this review are best suited to constitute a gold standard for guideline-based QI development. For this research, we provide a comprehensive groundwork.

Show MeSH
Related in: MedlinePlus