Background
Methods
Data sources and the selection of CPGs
Eligibility criteria
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QIs are reported.
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The CPG is an evidence-based CPG.
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The topic and recommendations are comparable with those of at least one of the 35 previously identified German S3-CPGs (see Additional file 1).
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The country of CPG development belongs to WHO-Stratum A [21].
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Date of publication between 2012 and 2017.
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Published in German, English, French, Spanish, Dutch, Norwegian, or Swedish.
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The current full-text version is available at no charge.
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The validity date of the CPG, indicated by the CPG developer, is not exceeded.
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Are based on a systematic literature search
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Are clearly identifiable and assigned with a grade of recommendation (GoR) and/or a level of evidence (LoE)
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Are linked to the references of the underlying evidence.
Literature search
Selection process
Data extraction
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Number of members and expertise of the QI development group (such as methodologists, clinicians, patient representatives)
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Label of the quality measure, e.g. QI, quality criteria and performance measure
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Categorization of QI into structure, process, or outcome indicators according to the definition of Donabedian [25] (in case of missing assignment by the guideline authors, our own assignment was made)
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Underlying recommendations and whether the QIs were based explicitly or implicitly on those
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Rationale reported for the QI
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Scientific measurement properties reported for the QI, e.g. reliability and validity [26]
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Intended purpose reported for the QI, e.g. quality reporting, quality management systems, and evaluation of CPGs
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Quality objectives reported
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Methods used for QI development, e.g. search for existing QIs, consensus methods, and assessment tools
Quality appraisal
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Systematic methods were used to search for evidence.
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The criteria for selecting the evidence are clearly described.
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The methods used for formulating the recommendations are clearly described.
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Health benefits, side effects, and risks have been considered in formulating the recommendations.
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There is an explicit link between the recommendations and the supporting evidence.
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The guideline has been externally reviewed by experts prior to its publication.
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A procedure for updating the guideline is provided.
Data synthesis
Results
Results of the literature search and characteristics of included CPGs
CPG pair no. | Topic | German S3-CPG (abbreviation) | CPG pair (n) | International CPG (abbreviation) |
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1 | Breast cancer | 032/045OL 2012 [61] | 1 | SIGN breast 2013 [42] |
2 | Ovarian cancer | 032/035OL 2013 [16] | 1 | SIGN ovar 2013 [44] |
3 | Prostate cancer | 043/022OL 2014 [51] | 1 | CTFPHC prostate 2014 [49] |
4 | Colorectal cancer | 021/007OL 2013 [58] | 2 | CTFPHC colorectal 2016 [48] |
5 | SIGN colorectal 2016 [33] | |||
6 | Oesophagus cancer | 021/023OL 2014 [64] | 1 | KCE gastrointest 2012 [28] |
7 | Gastric cancer | 032/009OL 2012 [60] | 1 | KCE gastrointest 2012 [28] |
8 | Palliative medicine | 128/001OL 2015 [65] | 1 | ICSI palliative 2013 [45] |
9 | Melanoma | 032/024OL 2016 [62] | 1 | SIGN melanoma 2017 [43] |
10 | Low-back pain | nvl/007 2015 [52] | 1 | ICSI backpain 2012 [39] |
11 | Kidney disease in diabetes | nvl/001d 2015 [63] | 3 | NICE diabtypeI 2015 [23] |
12 | NICE diabtypeII 2016 [24] | |||
13 | SNS diabtypeI 2012 [35] | |||
14 | Diabetes training | nvl/001f 2012 [53] | 4 | NICE diabtypeI 2015 [23] |
15 | NICE diabtypeII 2016 [24] | |||
16 | SNS diabtypeI 2012 [35] | |||
17 | ICSI diabtypeII 2014 [36] | |||
18 | Obesity | 050/001 2014*) [54] | 4 | CTFPHC obesity 2015 [50] |
19 | NICE obesity 2014 [29] | |||
20 | NICE weight 2014 [30] | |||
21 | ICSI obesity 2013 [31] | |||
22 | Diabetes and pregnancy | 057 – 023 2014*) [56] | 2 | NICE diabpreg 2015 [34] |
23 | SNS diabtypeI 2012 [35] | |||
24 | Bipolar disorder | 038 – 019 2012*) [55] | 1 | NICE bipolar 2016 [32] |
25 | Hysterectomy for benign diseases | 015 – 070 2014*) [57] | 1 | NICE menstrual bleeding 2016 [38] |
26 | Long-term opioid-use in non-cancer pain | 145 – 003 2014*) [59] | 2 | ICSI pain 2016 [40] |
27 | SIGN pain 2013 [41] | |||
28 | Venous thromboembolism | 003 – 001 2015*) [66] | 2 | SIGN VTEPrev 2014 [47] |
29 | CCHMC VTE 2014 [46] | |||
30 | Perioperative hypothermia | 001 – 018 2013*) [67] | 1 | ICSI hypo 2014 [37] |
Characteristics of guideline-based QIs
German S3-CPG | German S3-CPG (n = 18) | International CPG (n = 25) | |||
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Scientific medical societies (n = 7) | NDMG (n = 3) | GGPO (n = 8) | |||
Categorization of QI into structure (S), process (P), or outcome (O) indicator (according to own assignment) | |||||
S(n)/P(n)/O(n) | 10/48/5 | 0/14/0 | 0/61/14 | 10/123/19 | 3/133/30 |
Intended purpose of QI is reported | |||||
Yes (n) | 3 | 2 | 8 | 13 | 21 |
No (n) | 4 | 1 | 0 | 5 | 4 |
Rationale for QI is reported | |||||
Yes (n) | 1 | 0 | 0 | 1 | 1 |
No (n) | 6 | 3 | 8 | 17 | 24 |
QI is presented as ratio/proportion | |||||
n/N | 40/63 | 14/14 | 75/75 | 129/152 (85%) | 139/166 (84%) |
QI is based explicitly on one or more recommendations | |||||
n/N of that at least one strong recommendation/statement | 53/63 45% | 14/14 100% | 69/75 97% | 136/152 (89%) 77% | 82/166 (49%) 93% |
Measurement properties are reported | |||||
n/N | 0/63 | 0/14 | 0/75 | 0/152 | 0/166 |
Quality objectives are reported | |||||
n/N | 7/63 | 7/14 | 25/75 | 39/152 (26%) | 39/166 (23%) |
Comparison of QIs
30 CPG pairs | QI match (QI pair) | No match | ||
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QI “not different or slightly different” | QI “different/inconsistent” | QI only in international CPG | QI only in German S3-CPG | |
n = 27 | n = 2 | n = 137 | n = 183 |
Acronym international CPG | QIint[# (S/P/O); reference range rr; title] | Corresponding recommendation(s) (GoR, LoE) (explicit/implicit connection) | Acronym corresponding German S3-CPG | QIS3* [# (S/P/O); reference range rr; title] | Corresponding recommendation*) (GoR, LoE) (explicit/implicit connection) |
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QIs “different/inconsistent” | |||||
SIGN melanoma 2017 | #int3 (P); rr: 95% Multi-Disciplinary Team Meeting (MDT) Numerator: Number of patients with cutaneous melanoma discussed at the MDT before definitive treatment (wide local excision, chemotherapy/SACT, supportive care and radiotherapy). Denominator: All patients with cutaneous melanoma. (Exclusions: Patients who died before first treatment) | All patients with a diagnosis of melanoma should be discussed at a specialist multidisciplinary team (MDT) meeting (GPP). (implicit connection) | 032/024OL 2016 | #S310 (P); rr: N.R. Presentation melanoma team meeting Numerator: Patients with stage IV melanoma, who are presented in an interdisciplinary team meeting Denominator: Patients with stage IV melanoma | 3.146 Patients with metastatic melanoma (as of stage III) should be presented in an in an interdisciplinary team meeting to discuss further diagnostic and therapy. […] (strong rec., consensus-based) (explicit connection) |
SIGN ovar 2013 | #int9 (P); rr: 90% First-line Chemotherapy Numerator: Number of epithelial ovarian cancer patients who receive chemotherapy treatment involving either paclitaxel in combination with a platinum-based compound or carboplatin only Denominator: All epithelial ovarian cancer patients (Exclusions: • Patients with low-grade serous disease. • Patients with FIGO stage 1a or 1b, low grade (G1) disease. • Patients with Stage 1a clear cell tumours. • Patients who decline chemotherapy treatment.) | #int9: First line chemotherapy treatment of epithelial ovarian cancer should include a platinum agent either in combination or as a single agent, unless specifically contraindicated (GoR: A, LoE: 1++). Carboplatin is the platinum drug of choice in both single and combination therapy (GoR: A, LoE: 1++). (implicit connection) | 032/035OL 2013 | #S310 (P); rr: N.R. Combination therapy for platinum sensitive relapse Numerator: Number of patients with a platinum-based combination therapy Denominator: All patients with platinum-sensitive relapse of an ovarian carcinoma and chemotherapy, outside of clinical studies | 9.5 Patients with platinum-sensitive relapse of an ovarian carcinoma should receive with a platinum-based combination therapy if there is the indication for chemotherapy (strong rec., consensus-based). […] (explicit connection) |
QIs “not different/slightly different” | |||||
KCE gastrointest 2012 | #int1 (P); rr: N.R. Staging Numerator: All patients diagnosed with oesophageal cancer in a given year discussed at the multidisciplinary team (MDT) meeting within 1 month after incidence date. Denominator: All patients diagnosed with oesophageal cancer in a given year. | All patients diagnosed with oesophageal cancer should be discussed at a multidisciplinary meeting (GoR: strong, LoE: low). (explicit connection) | 021/023OL 2014 | #S34 (P); rr: N.R. Therapy recommendation from multidisciplinary tumour conference Numerator: Number of patients with therapy recommendation from multidisciplinary tumour conference before therapy (staging completed) Denominator: All patients with oesophageal cancer | Therapy recommendations should be made in a multidisciplinary tumour conference. […] (strong rec., consensus-based). (explicit connection) |
NICE diabtypeI 2015 and NICE diabtypeII 2016 | #int1 (P); rr: N.R. NM27 The percentage of patients newly diagnosed with diabetes, on the register, in the preceding 1 April to 31 March who have a record of being referred to a structured education programme within 9 months after entry on to the diabetes register. | NICE diabtypeI 2015: rec 1.3.1 Offer all adults with type 1 diabetes a structured education programme of proven benefit, for example the DAFNE (dose-adjustment for normal eating) programme. Offer this programme 6–12 months after diagnosis (strong rec). NICE diabtypeII 2016: rec 1.2.1 Offer structured education to adults with type 2 diabetes and/or their family members or carers (as appropriate) at and around the time of diagnosis, with Type 2 diabetes in adults: management annual reinforcement and review. Explain to people and their carers that structured education is an integral part of diabetes care (strong rec). (explicit connections) NICE diabtypeII 2016: rec 1.2.2 […] | nvl/001f 2012 | #S31 (P); rr: N.R. Numerator: Number of patients, for which the offer of a structured education program is documented directly after the diagnosis is being made Denominator: All people with newly diagnosed diabetes mellitus | 2-1 Each human with diabetes mellitus and if necessary important reference persons (e.g. relatives) should be offered a structured education program as an indispensable component of the diabetes management directly after the diagnosis is made and regularly in the course of the disease (GoR ⇑⇑). (explicit connection) |
ICSI backpain 2012 | #int3 (P); rr: N.R. Numerator: Number of patients for whom the clinician ordered imaging studies during the six weeks after pain onset, in the absence of "red flags." Denominator: Number of patients with non-specific back pain diagnosis. | Annotation #11 • […] • Clinicians should not recommend imaging (including computed tomography (CT), magnetic resonance imaging (MRI) and x-ray) for patients with non-specific low back pain (strong rec, moderate quality evidence). […] (explicit connection) | nvl/007 2011 | #S32 (P); rr: N.R. Imaging techniques for acute back pain Numerator: Number of patients for which imaging diagnostics is conducted without reason Denominator: All patients with acute back pain and without “red flags” after anamnesis and clinical examination. | 3-5 Imaging diagnostics is not recommended in case of acute back pain after exclusion of dangerous conditions by anamnesis and clinical examination (GoR ⇓⇓). (explicit connection) |
NICE bipolar 2016 | #int2 (P); rr: N.R. NM16 The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of BMI in the preceding 15 months | Rec 1.2.12 Ensure that the physical health check for people with bipolar disorder, performed at least annually, includes: • weight or BMI, diet, nutritional status and level of physical activity • […] (explicit connection) | 038/019 2012 | #S318 (P); rr: N.R. General principle Numerator: Percentage of patients, for whom weight data are documented repeatedly. Denominator: All patients | Therapy-general principle 4 Regular weight controls should be conducted because of possible weight gain, especially during therapy with mirtazapine, tricyclic antidepressants, lithium, valproic acid, clozapine, olanzapine, quetiapine, risperidone, and zotepine. (moderate rec., consensus-based) (explicit connection) |
QIs not comparable (“QI only in international respectively S3-CPG”) | |||||
ICSI diabtypeII 2014 | #int1 (P); rr: N.R. Numerator: Number of patients who are advised about lifestyle modification and nutrition therapy within one year of diagnosis. Denominator: Number of patients ages 18–75 years old who have T2DM. | Nutrition therapy A qualified health professional (which may include a clinician, dietitian, nursing staff and pharmacist) should provide nutrition therapy to a patient diagnosed with T2DM as part of a global treatment plan (GoR: strong, quality of evidence: moderate). (explicit connection) | nvl/001f 2012 | #S31 (P); rr: N.R. Numerator: Number of patients, for which the offer of a structured education program is documented directly after the diagnosis is being made Denominator: All people with newly diagnosed diabetes mellitus | 2-1 Each human with diabetes mellitus and if necessary important reference persons (e.g. relatives) should be offered a structured education program as an indispensable component of the diabetes management directly after the diagnosis is made and regularly in the course of the disease (GoR ⇑⇑). (explicit connection) |
SIGN VTEPrev 2014 | #int1 (P); rr: N.R. Compliance with and recording of risk assessment in all patients admitted to or presenting acutely at hospital. | All patients admitted to hospital or presenting acutely to hospital should be individually assessed for risk of VTE and bleeding. The risks and benefits of prophylaxis should be discussed with the patient (GoR: D). (implicit connection) | 003/001 2015 | S32 (P); rr: ≥ 95 % Proportion of patients with documented information about benefits, risks and alternatives of prophylactic interventions in relation to all patients receiving VTE prophylaxis. | 3.8 The conducted risk assessment of a VTE and the resulting interventions of a VTE prophylaxis have to be discussed with the patient regarding benefits, risks and alternatives (according to legal requirements) (GoR ⇑⇑) (explicit connection) |
ICSI pain 2016 | int4 (P); rr: N.R. Numerator: Number of patients with new opioid prescriptions that are <= 20 pills or 3 days’ supply of short-acting opioid. Denominator: Number of patients with chronic pain diagnosis with a new opioid prescription (no opioid prescription for at least 90 days). Exclude patients with an opioid prescription for cancer, migraine and end-of-life care. | Acute or acute on chronic pain • The first opioid prescription for acute pain should be no more than 20 low-dose, short-acting opioids or three days of medication, whichever is less. The total dose for acute pain should not exceed 100 MME. • For patients presenting in acute pain, already on chronic opioids, opioid tolerant or on methadone, use the same pill and dose limits as for opioid-naïve patients (strength of rec. N.R.). (explicit connection) | 145/003 2014 | # S31 (P); rr: N.R. Number of patients with somatoform pain disorders, which receive opioid analgesics. | Pain associated with functional/somatoform disorders should not be treated with opioid analgesics (consensus-based). (explicit connection) |
Methods for the development of QIs
German S3-CPG | German S3-CPG (n = 18) | International CPG (n = 25) | |||
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Scientific medical societies (n = 7) | NDMG (n = 3) | GGPO (n = 8) | |||
Searches for existing QI | |||||
Yes (n) | 1 | 3 | 5 | 9 | 1 |
No/not reported (n) | 6 | 0 | 3 | 9 | 24 |
External data sources (reference to published QI) | |||||
Yes (n) | 3 | 0 | 6 | 9 | 4 |
No/not reported (n) | 4 | 3 | 2 | 9 | 25 |
Formal consensus procedures for adopting QI | |||||
Yes (n) | 1 | 3 | 8 | 12 | 1 |
No/not reported (n) | 6 | 0 | 0 | 6 | 24 |
Use of formal criteria/tools for assessment of QI | |||||
Yes (n) | 1 | 3 | 8 | 12 | 8 |
No/not reported (n) | 6 | 0 | 0 | 6 | 17 |
Piloting/ evaluation of QI | |||||
Yes (n) | 0 | 0 | 0 | 0 | 8 |
No/not reported (n) | 7 | 2 | 7 | 16 | 17 |
Planned (n) | 0 | 1 | 1 | 2 | 0 |