Article type
Year
Abstract
Introduction/Objective: There is an increasing interest in the potential of clinical guidelines to improve quality of care. As a consequence, thousands of German-language recommendations for health professionals have been distributed under the label "Clinical Guideline" during recent years, the quality of which range from excellent to questionable. In order to set standards for "Good Clinical Guidelines" in Germany, the Agency for Quality in Medicine developed critical appraisal criteria for clinical guidelines, which were adapted and published by GMA and NASHIP in 1997. They are mandatory for all German physicians. We report on the development procedure, the underlying literature, and on the essentials of that guideline for clinical guidelines.
Methods: In order to base quality criteria for clinical guidelines on a broad professional expertise, the Agency installed a multiprofessional Clinical Guidelines Working Group, in which representatives of the following specialties were represented: epidemiology, general medicine, internal medicine, legal medicine medical economics, medical education, social medicine, professional and social law. The results of the Working Group were reviewed by the Agency's Steering Group. Proposals for critical appraisal criteria were gained from international experts, congresses, literature, and electronic databases via internet.
Results: The Working Group based the critical appraisal criteria for German clinical guidelines heavily on a criteria originally published by the US-Institute of Medicine; the work of AHCPR, the Scottish Intercollegiate Guidelines Network, the Canadian Medical Association, and of the German Association of Scientific Medical Societies. As essential criteria of clinical guidelines the following attributes were accepted: transparency of evidence, validity, reliability, multiprofessional development, clinical applicability, flexibility, clarity, documentation, scheduled review. The criteria reflect the standard methodology for guideline development sponsored by the GMA and NASHIP. For each guideline the Working Group suggested problem-based implementation instruments using a draft quick reference guide, patient reminders, CME materials, minimum data sets.
Discussion: The internationally accepted essentials of good clinical guidelines were adapted by GMA and NASHIP in Germany and published as "Critical Appraisal Criteria for Clinical Guidelines" in the "Deutsche Arzteblatt", which is delivered to all German physicians. In the future, only guidelines based on those criteria, will be sponsored or adapted by self governmental bodies of German physicians. In the near future the Agency for Quality in Medicine will evaluate the criteria's effects on guideline development in Germany.
Methods: In order to base quality criteria for clinical guidelines on a broad professional expertise, the Agency installed a multiprofessional Clinical Guidelines Working Group, in which representatives of the following specialties were represented: epidemiology, general medicine, internal medicine, legal medicine medical economics, medical education, social medicine, professional and social law. The results of the Working Group were reviewed by the Agency's Steering Group. Proposals for critical appraisal criteria were gained from international experts, congresses, literature, and electronic databases via internet.
Results: The Working Group based the critical appraisal criteria for German clinical guidelines heavily on a criteria originally published by the US-Institute of Medicine; the work of AHCPR, the Scottish Intercollegiate Guidelines Network, the Canadian Medical Association, and of the German Association of Scientific Medical Societies. As essential criteria of clinical guidelines the following attributes were accepted: transparency of evidence, validity, reliability, multiprofessional development, clinical applicability, flexibility, clarity, documentation, scheduled review. The criteria reflect the standard methodology for guideline development sponsored by the GMA and NASHIP. For each guideline the Working Group suggested problem-based implementation instruments using a draft quick reference guide, patient reminders, CME materials, minimum data sets.
Discussion: The internationally accepted essentials of good clinical guidelines were adapted by GMA and NASHIP in Germany and published as "Critical Appraisal Criteria for Clinical Guidelines" in the "Deutsche Arzteblatt", which is delivered to all German physicians. In the future, only guidelines based on those criteria, will be sponsored or adapted by self governmental bodies of German physicians. In the near future the Agency for Quality in Medicine will evaluate the criteria's effects on guideline development in Germany.