International journal for quality in health care : journal of the International Society for Quality in Health Care
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Int J Qual Health Care · Feb 1999
ReviewDevelopment and application of a generic methodology to assess the quality of clinical guidelines.
Despite clinical guidelines penetrating every aspect of clinical practice and health policy, doubts persist over their ability to improve patient care. We have designed and tested a generic critical appraisal instrument, that assesses whether developers have minimized the biases inherent in creating guidelines, and addressed the requirements for effective implementation. ⋯ Use of this instrument should encourage developers to create guidelines that reflect relevant research evidence more accurately. Potential users or groups adapting guidelines for local use could apply the instrument to help decide which one to follow. The National Health Service Executive is using the instrument to assist in deciding which guidelines to recommend to the UK National Health Service. This methodology forms the basis of a common approach to assessing guideline quality in Europe.
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To compare crude and adjusted in-hospital mortality rates after prostatectomy between hospitals using routinely collected hospital discharge data and to illustrate the value and limitations of using comparative mortality rates as a surrogate measure of quality of care. ⋯ Regression adjustment of routinely collected data on prostatectomy from the Victorian Inpatient Minimum Database reduced variance associated with age and correlates of illness severity. Reduction of confounding in this way is a move in the direction of exploring differences in quality of care between hospitals. Collection of such information over time, together with refinement of data collection would provide indicators of change in quality of care that could be explored in more detail as appropriate in the clinical setting.