Approaches of integrating the development of guidelines and quality indicators: a systematic review

Miranda W Langendam¹, Thomas Piggott², Monika Nothacker³, Arnav Agarwal⁴, David Armstrong⁵, Tejan Baldeh¹, Jeffrey Braithwaite⁶, Carolina Castro Martins^{2

7}, Andrea Darzi², Itziar Etxeandia⁸, Ivan Florez^{1

9}, Jan Hoving¹⁰, Samer G Karam², Thomas Kötter¹¹, Joerg J Meerpohl¹², Reem A Mustafa^{2

13}, Giovanna E U Muti-Schünemann¹⁴, Philip J van der Wees¹⁵, Markus Follmann¹⁶, Holger J Schünemann^{17

18

19}

Affiliations

¹ Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health institute, Amsterdam, Netherlands.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
³ Institute of Medical Knowledge Management, Association of the Scientific Medical Societies, Berlin, Germany.
⁴ Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Canada.
⁶ Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, Australia.
⁷ Department of Pediatric Dentistry, Dental School, Federal University of Minas Gerais, Belo Horizonte, Brazil.
⁸ IKOetxe - Ikerkuntza Osaungintza, Health Research, Gipuzkoa, Irun, Basque Country, Spain.
⁹ Department of Pediatrics, University of Antioquia, Medellin, Colombia.
¹⁰ Coronel Institute of Occupational Health and Research Center for Insurance Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
¹¹ Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
¹² Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
¹³ Department of Internal Medicine, University of Kansas Medical Center, Kansas, USA.
¹⁴ Department of Systemic Pathology, Vita Salute San Raffaele University, Milan, Italy.
¹⁵ Department of Rehabilitation and IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
¹⁶ German Cancer Society, Freiburg, Germany.
¹⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. schuneh@mcmaster.ca.
¹⁸ Department of Medicine, Hamilton, McMaster University, Hamilton, Canada. schuneh@mcmaster.ca.
¹⁹ Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada. schuneh@mcmaster.ca.

PMID: 32938461
PMCID: PMC7493171
DOI: 10.1186/s12913-020-05665-w

Approaches of integrating the development of guidelines and quality indicators: a systematic review

Miranda W Langendam et al. BMC Health Serv Res. 2020.

. 2020 Sep 16;20(1):875.

doi: 10.1186/s12913-020-05665-w.

Authors

Affiliations

¹ Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health institute, Amsterdam, Netherlands.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
³ Institute of Medical Knowledge Management, Association of the Scientific Medical Societies, Berlin, Germany.
⁴ Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Canada.
⁶ Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, Australia.
⁷ Department of Pediatric Dentistry, Dental School, Federal University of Minas Gerais, Belo Horizonte, Brazil.
⁸ IKOetxe - Ikerkuntza Osaungintza, Health Research, Gipuzkoa, Irun, Basque Country, Spain.
⁹ Department of Pediatrics, University of Antioquia, Medellin, Colombia.
¹⁰ Coronel Institute of Occupational Health and Research Center for Insurance Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
¹¹ Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
¹² Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
¹³ Department of Internal Medicine, University of Kansas Medical Center, Kansas, USA.
¹⁴ Department of Systemic Pathology, Vita Salute San Raffaele University, Milan, Italy.
¹⁵ Department of Rehabilitation and IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
¹⁶ German Cancer Society, Freiburg, Germany.
¹⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. schuneh@mcmaster.ca.
¹⁸ Department of Medicine, Hamilton, McMaster University, Hamilton, Canada. schuneh@mcmaster.ca.
¹⁹ Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada. schuneh@mcmaster.ca.

PMID: 32938461
PMCID: PMC7493171
DOI: 10.1186/s12913-020-05665-w

Abstract

Background: Guidelines and quality indicators (for example as part of a quality assurance scheme) aim to improve health care delivery and health outcomes. Ideally, the development of quality indicators should be grounded in evidence-based, trustworthy guideline recommendations. However, anecdotally, guidelines and quality assurance schemes are developed independently, by different groups of experts who employ different methodologies. We conducted an extension and update of a previous systematic review to identify, describe and evaluate approaches to the integrated development of guidelines and related quality indicators.

Methods: On May 24th, 2019 we searched in Medline, Embase and CINAHL and included studies if they reported a methodological approach to guideline-based quality indicator development and were published in English, French, or German.

Results: Out of 16,034 identified records, we included 17 articles that described a method to integrate guideline recommendations development and quality indicator development. Added to the 13 method articles from original systematic review we included a total 30 method articles. We did not find any evaluation studies. In most approaches, guidelines were a source of evidence to inform the quality indicator development. The criteria to select recommendations (e.g. level of evidence or strength of the recommendation) and to generate, select and assess quality indicators varied widely. We found methodological approaches that linked guidelines and quality indicator development explicitly, however none of the articles reported a conceptual framework that fully integrated quality indicator development into the guideline process or where quality indicator development was part of the question formulation for developing the guideline recommendations.

Conclusions: In our systematic review we found approaches which explicitly linked guidelines with quality indicator development, nevertheless none of the articles reported a comprehensive and well-defined conceptual framework which integrated quality indicator development fully into the guideline development process.

Keywords: Guidelines; Quality assurance; Quality improvement; Recommendations.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
a Flow chart original review by Kötter et al. b Flow chart update original systematic review by Kötter et al.

See this image and copyright information in PMC

References

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Approaches of integrating the development of guidelines and quality indicators: a systematic review

Affiliations

Approaches of integrating the development of guidelines and quality indicators: a systematic review

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical