Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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The value of consensus recommendations for improving clinical practice may be restricted by the limitations of the evidence on which they are based. When few high quality studies are identified for evaluation from the specific field of interest, selected 'transferable' evidence from comparable clinical situations may add important information. ⋯ In particular, systems for grading of recommendations must take into account the different types of evidence used, so as not to give equivalent weight to transferable and specific evidence without justification. In this article, we discuss the use of transferable evidence by the PROSPECT Working Group, which has developed a clinical decision support programme (www.postoppain.org) to provide evidence and recommendations for procedure-specific postoperative pain management.
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Quality indicators are used world-wide to control the quality of health care. To be effective these indicators have to meet quality criteria themselves. But until now there has been no fully operational method for assessing indicators. ⋯ Particular characteristics of QUALIFY include clear definitions of all criteria, consistent information as the basis of assessment and a standardized approach throughout the assessment process. QUALIFY comprises 20 criteria which are assigned to the three categories relevance, scientific soundness and feasibility. It was tested during the assessment of 55 indicators and served as the methodological basis for selecting those quality indicators that German hospitals are required to report publicly.
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Z Arztl Fortbild Qualitatssich · Jan 2007
Shared decision-making in Canada: update, challenges and where next!
There is considerable interest for shared decision-making (SDM) within the Canadian healthcare system. The current state of SDM in Canada and challenges with implementation are addressed in the paper at three levels of patient involvement: (1) healthcare system (macro-level); (2) institutions (meso-level) and (3) clinical/medical encounter (micro-level). ⋯ The virtue of SDM has gained recognition through increased research funding, medical training and some initiatives embedding patient decision aids within the process of care. Future perspectives of SDM in Canada are highlighted such as evaluation of the long-term impact of and costs associated with patient participation in decisions as well as interprofessional approaches to SDM.
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Z Arztl Fortbild Qualitatssich · Jan 2007
[Participation of patients in the program for national disease management guidelines--current state and implications].
Patient involvement has been implemented in the Program for National Disease Management Guidelines since 2005. Currently patient/consumer participation is being incorporated in terms of patients' comments of consultation papers on National Disease Management Guidelines (NDMG) and in the development of NDMG-based patient guidelines (PG). The editorial activities in patient guideline development from the beginnings to its publication are conducted in close cooperation with the patient representatives appointed by the Patient Forum. ⋯ It describes the current state of patient involvement and joint work and indicates the implications that can be derived from patient participation in the NDMG Program. Accompanying the involvement procedures, experiences resulting from previous NDMG and PG development activities are continuously investigated for the possibility of further methodological development of consumer participation by a work group of the Patient Forum in coordination with the patient organizations involved. In particular, the procedures resulting from more intensive patient participation in patient guideline development are to be examined as to their relevance for the expansion of patient involvement in NDMG development.
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Z Arztl Fortbild Qualitatssich · Jan 2007
[Can rationing be fair? Ethical considerations regarding justice in the healthcare system].
While economy tries to solve the problem of scarcity by rationing, i.e. increasing efficiency, ethics reflect the path of the just distribution of scarce goods, necessarily including the means of transparent and fair rationing. But how can such rationing be realised in a healthcare system? Non-medical criteria such as the patient's social function or age, though vividly discussed, are inappropriate. ⋯ The QALY and DALY models are such an attempt. Careful reflection of these measures of quality of life and, in some aspects, accompanying rules to avoid extreme unfairness will be critical to their success.