Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen
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Z Evid Fortbild Qual Gesundhwes · Jan 2011
[Quality indicators for National Disease Management Guidelines using the example of the National Disease Management Guideline for "Chronic Heart Failure"].
Together with an expert committee a structured approach to determining quality indicators for National Disease Management Guidelines has been developed. The key steps of this approach include: introducing guideline authors to the methodology at an early stage of the process of guideline development, pre-selecting recommendations of the guideline which are potentially measurable by means of quality indicators, assessing the potentially measurable quality indicators in written form using five criteria (including their importance for the health care system and clarity of definitions) and approving them in a formal consensus process. For lack of a database these quality indicators must be regarded as preliminary. ⋯ In a second step, the quality indicators have to be validated within a pilot project. The determination and assessment of the potential quality indicators have revealed room for improvement of guideline development. In particular, there is a need for more health care data and for specification of recommendations.
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Z Evid Fortbild Qual Gesundhwes · Jan 2011
[The "outcome benchmarking in rheumatologic acute care" project of the Association of Rheumatologic Acute Care Clinics (VRA e.V.) in Germany].
By initiating and taking part in the pilot project obra (outcome benchmarking in rheumatologic acute care), which was supported by the German Ministry of Health, the rheumatologic hospitals committed themselves to the continuous improvement of quality through a collective benchmarking and learning process. In addition to verifiable and concrete improvements in quality, the major achievements of the obra pilot project include a cultural change in the participating hospitals as well as the continuation of outcome benchmarking and its expansion to an increasing number of hospitals.
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Z Evid Fortbild Qual Gesundhwes · Jan 2011
Shared decision making in the United States: policy and implementation activity on multiple fronts.
Shared decision making in the United States has become an important element in health policy debates. The recently passed federal health care reform legislation includes several key provisions related to shared decision making (SDM) and patient decision support. Several states have passed or are considering legislation that incorporates SDM as a key component of improved health care provision. ⋯ Numerous professional organizations are advocating for SDM and social networking efforts are increasing their advocacy as well. Policy makers are intrigued by the potential of SDM to improve health care provision and potentially lower costs. The role of shared decision making in policy and practice will be part of the larger health care reform debate.
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Z Evid Fortbild Qual Gesundhwes · Jan 2011
[QUIPS: quality improvement in postoperative pain management].
Despite the availability of high-quality guidelines and advanced pain management techniques acute postoperative pain management is still far from being satisfactory. The QUIPS (Quality Improvement in Postoperative Pain Management) project aims to improve treatment quality by means of standardised data acquisition, analysis of quality and process indicators, and feedback and benchmarking. During a pilot phase funded by the German Ministry of Health (BMG), a total of 12,389 data sets were collected from six participating hospitals. ⋯ QUIPS demonstrates that patient-reported outcomes in postoperative pain management can be benchmarked in routine clinical practice. Quality improvement initiatives should use outcome instead of structural and process parameters. The concept is transferable to other fields of medicine.
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Z Evid Fortbild Qual Gesundhwes · Jan 2011
[Balancing benefit and harm in palliative care: the difficult position of palliative medicine in view of the promises of curative medicine].
The significance of palliative care as an interdisciplinary and multi-professional approach to treating patients with extremely severe medical conditions should be investigated using the same methodological standards as for clinical medicine in general. Clinical studies in palliative medicine show that certain standards, e.g. in pain therapy, have still not been sufficiently implemented. There is also a lack of methodologically appropriate studies to investigate palliative medicine as a complex intervention. This research deficit is all the more regrettable as - specifically in the field of oncology - it can be demonstrated that the benefit provided by the services of palliative care teams is very large, especially for patients with a particularly unfavorable course of the disease.