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Publication guidelines for quality improvement studies in health care: evolution of the SQUIRE project.

BMJ. 2009;338:a3152

Authors: Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney SE,

In 2005 we published draft guidelines for reporting studies of quality improvement, as the initial step in a consensus process for development of a more definitive version. The current article contains the revised version, which we refer to as standards for quality improvement reporting excellence (SQUIRE). This narrative progress report summarises the special features of improvement that are reflected in SQUIRE, and describes major differences between SQUIRE and the initial draft guidelines. It also briefly describes the guideline development process; considers the limitations of and unresolved questions about SQUIRE; describes ancillary supporting documents and alternative versions under development; and discusses plans for dissemination, testing, and further development of SQUIRE.

PMID: 19153129 [PubMed - indexed for MEDLINE]

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[Visualization of a myth - The new S3 guidelines for fibromyalgia syndrome.]

Schmerz. 2009 Jan 22;

Authors: Widder B, Häuser W

PMID: 19156447 [PubMed - as supplied by publisher]

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[S3-guideline "Helicobacter pylori and gastroduodenal ulcer disease"]

Z Gastroenterol. 2009 Jan;47(1):68-102

Authors: Fischbach W, Malfertheiner P, Hoffmann JC, Bolten W, Bornschein J, Götze O, Höhne W, Kist M, Koletzko S, Labenz J, Layer P, Miehlke S, Morgner A, Peitz U, Preib JC, Prinz C, Rosien U, Schmidt WE, Schwarzer A, Suerbaum S, Timmer A, Treiber G, Vieth M

This guideline updates a prior concensus recommendation of the German Society for Digestive and Metabolic Diseases (DGVS) from 1996. It was developed by an interdisciplinary cooperation with representatives of the German Society for Microbiology, the Society for Pediatric Gastroenterology and Nutrition (GPGE) and the German Society for Rheumatology. The guideline is methodologically based on recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) for providing a systematic evidence-based consensus guideline of S 3 level and has also implemented grading criteria according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Clinical applicability of study results as well as specifics for Germany in terms of epidemiology, antibiotic resistance status, diagnostics and therapy were taken into account.

PMID: 19156594 [PubMed - in process]

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Adherence to Practice Guidelines, Clinical Outcomes, and Costs Among Medicaid Enrollees With Severe Mental Illnesses.

Eval Health Prof. 2009 Jan 21;

Authors: Stiles PG, Boothroyd RA, Dhont K, Beiler PF, Green AE

The treatment of Medicaid enrollees diagnosed with depression or schizophrenia was examined to determine whether adherence to treatment guideline was associated with health care financing strategy, clinical outcomes, and cost-effectiveness. Individuals in a fee-for-service condition were significantly more likely to receive treatment consistent with guidelines than those in managed care. Mental health costs were higher for individuals diagnosed with schizophrenia, individuals in an acute phase of illness at intake into the study, and those receiving treatment consistent with practice guidelines. Being in an acute phase of illness and having treatment that comported with recommended practice guidelines were associated with higher total social costs. Policy implications of the findings and recommendations for future research are discussed.

PMID: 19164300 [PubMed - as supplied by publisher]

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Effect of implementation of new resuscitation guidelines on quality of cardiopulmonary resuscitation and survival.

Resuscitation. 2009 Jan 21;

Authors: Olasveengen TM, Vik E, Kuzovlev A, Sunde K

BACKGROUND: During cardiopulmonary resuscitation (CPR), advanced life support (ALS) providers have been shown to deliver inadequate CPR with long intervals without chest compressions. Several changes made to the 2005 CPR Guidelines were intended to reduce unnecessary interruptions. We have evaluated if quality of CPR performed by the Oslo Emergency Medical System (EMS) improved after implementation of the modified 2005 CPR Guidelines, and if any such improvement would result in increased survival. MATERIALS AND METHODS: Retrospective, observational study of all consecutive adult cardiac arrest patients treated during a 2-year period before (May 2003-April 2005), and after (January 2006-December 2007) implementation of the modified 2005 CPR Guidelines. CPR quality was assessed from continuous electronic recordings from LIFEPACK 12 defibrillators where ventilations and chest compressions were identified from transthoracic impedance changes. Ambulance run sheets, Utstein forms and hospital records were collected and outcome evaluated. RESULTS: Resuscitation was attempted in 435 patients before and 481 patients after implementation of the modified 2005 CPR Guidelines. ECGs usable for CPR quality evaluation were obtained in 64% and 76% of the cases, respectively. Pre-shock pauses decreased from median (interquartile range) 17s (11, 22) to 5s (2, 17) (p=0.000), overall hands-off ratios from 0.23+/-0.13 to 0.14+/-0.09 (p=0.000), compression rates from 120+/-9 to 115+/-10 (p=0.000) and ventilation rates from 12+/-4 to 10+/-4 (p=0.000). Overall survival to hospital discharge was 11% and 13% (p=0.287), respectively. CONCLUSION: Quality of CPR improved after implementation of the modified 2005 Guidelines with only a weak trend towards improved survival to hospital discharge.

PMID: 19167148 [PubMed - as supplied by publisher]

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A Qualitative Application of the Diffusion of Innovations Theory to Examine Determinants of Guideline Adherence Among Physical Therapists.

Phys Ther. 2009 Jan 23;

Authors: Harting J, Rutten GM, Rutten ST, Kremers SP

Background Evidence-based practice has become a major issue in physical therapy. Many evidence-based guidelines, however, are not used extensively after dissemination, and interventions aimed at increasing guideline adherence often have limited effects. Objective As a prerequisite for changing this situation, the aims of this study were to gain an in-depth understanding of the determinants of guideline adherence among physical therapists in the Netherlands and to evaluate the opportunities of a theoretical framework in this respect. Design and METHODS:/b> This observational study consisted of 3 focus group interviews (n=12, 10, and 8) between November 2002 and January 2003. Physical therapists were asked to discuss their opinions about and experiences with the Dutch guidelines for low back pain. Data were analyzed qualitatively using a directed approach to content analysis. Both the interview route and the analysis of the interviews were informed by Rogers' Diffusion of Innovations Theory. RESULTS: /b> Our study yielded in-depth insights into the various determinants of guideline adherence. Overall, the participants had rather unfavorable opinions about issues related to the dissemination of the guidelines (first phase of the diffusion process) and provided relatively little information on the subsequent adoption process (second phase of the diffusion process). The theoretical framework appeared to be a useful tool to properly structure the focus group interviews, to systematically analyze the data collected, and to determine that supplementary interviews would be necessary to cover the entire diffusion process. CONCLUSIONS:/b> Our findings indicated that the diffusion process of guidelines among physical therapists was not yet completed. The use of theory can provide added value to guideline implementation studies.

PMID: 19168713 [PubMed - as supplied by publisher]

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[Enfuvirtide in HIV Patients: A Nursing Guideline for medication management.]

Pflege. 2009 Feb;22(1):29-38

Authors: Bigler S, Nicca D, Spirig R

Fusion inhibitors can be an effective salvage therapy in HIV-patients with multiple resistances. However, the management and maintenance of the therapy, which requires percutaneous self-administration, can be a difficult task for patients. Preparation and administration are time-consuming and may force patients to alter their daily routine. Therefore, appropriate counselling and training is important. Evidence-based guidelines can help health care professionals to provide continuing high quality care. The department of Clinical Nursing Science at the University Hospital Basel have developed a nursing guideline, which formulates patient-management from decision-making up to the support needed in long-time treatment maintenance. The main focus of this article lies on the theoretical framework of this guideline and a description of its key elements. These are important aspects of managing the treatment of chronic illness in general. Therefore, this article addresses all health care providers supporting chronically ill patients in their medication management.

PMID: 19173176 [PubMed - in process]

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Guideline adherence and patient satisfaction in the treatment of inflammatory bowel disorders - an evaluation study.

BMC Health Serv Res. 2009 Jan 27;9(1):17

Authors: Pieper C, Haag S, Gesenhues S, Holtmann G, Gerken G, Joeckel KH

ABSTRACT: BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are the most frequent inflammatory bowel disorders (IBD). IBD cause a significant burden to society due to extensive health care utilization from the first clinical symptoms until diagnosis and thereafter due to direct and indirect costs. Besides the socio-economic impact of CD and UC, gastrointestinal and extraintestinal symptoms affect quality of life, but there is remarkably little data about the quality of treatment as assessed by patient satisfaction, quality of life and adherence to guidelines. Thus the aim of this study was to identify variables that influence quality of treatment and quality of life as well as patient satisfaction. METHODS: The Essener Zirkel Study was a cross sectional study of 86 IBD-patients with a confirmed diagnosis of CD or UC. They were recruited at primary, secondary and tertiary care settings. Quality of treatment, quality of life and patient satisfaction were evaluated. Consulting behaviour and number of examinations, duration of disease and variables regarding adherence to guidelines were evaluated, too. RESULTS: 59 (69%) patients had CD and 27 had UC (31%). 19% spent more than four years until the suspected diagnosis of IBD was confirmed and visited more than five physicians. All patients showed a significantly reduced quality of life compared to the 1998 German normative population. In spite of being under medical treatment, nearly half of the patients suffered from strong quality of life restricting symptoms. Over all, 35 % described their treatment as moderate or bad. Patients who consulted psychotherapists and non-medical practitioners suffered significantly less from depression. CONCLUSION: Besides structural deficiencies due to the health care policy, we revealed the adherence to guidelines to be a problem area. Our findings support the assumption, that providing better health care and especially maintaining constant patient-physician communication improves patient satisfaction.

PMID: 19173739 [PubMed - as supplied by publisher]

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Agreement of Swiss-Adapted International and European Guidelines for the Assessment of Global Vascular Risk and for Lipid Lowering Interventions.

Cardiovasc Drugs Ther. 2009 Jan 29;

Authors: Romanens M, Ackermann F, Abay M, Szucs T, Schwenkglenks M

BACKGROUND: The Swiss national guidelines for the prevention of cardiovascular events have been published in 2005 by the Swiss Society of Cardiology (SGK) and the working group on lipids and atherosclerosis (AGLA). An agreement for global cardiovascular risk assessment and indications for cholesterol lowering among the international (IAS-AGLA) and the European (ESC score) guidelines is unknown. MATERIAL AND METHODS: Subjects aged >/=45 years were recruited using newspaper announcements for the participation in our free of charge cardiovascular prevention program of the Vascular Risk Foundation (Varifo). The data served to calculate cardiovascular 10 year risk and to compare IAS-AGLA und ESC score with respect to risk and lipid lowering indications. RESULTS: The primary prevention group included 713 subjects aged 55 +/- 6 years of which 47% were women. The mean 10-year risk +/- standard deviation was low (IAS-AGLA: 3.9% +/- 4.4% for myocardial infarction; ESC score: 1.7% +/- 1.8% for cardiovascular death). In those subjects qualifying for a lipid lowering intervention, according to the IAS-AGLA score or the ESC score, the percentage of agreement between both scores was only 18% (kappa value 0.31 [95%CI: 0.22-0.39], p < 0.0001). CONCLUSIONS: Our study shows, that the agreement for the available Swiss guidelines (IAS-AGLA, ESC score) for initiation of a lipid lowering therapy is low in our primary prevention group of subjects aged 45-65 years. According to the PROCAM study, about 30% of myocardial infarctions occur in persons with an intermediate risk. Therefore an improved risk stratification strategy is necessary.

PMID: 19184388 [PubMed - as supplied by publisher]

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A multifaceted intervention to improve blood pressure control: The Guideline Adherence for Heart Health (GLAD) study.

Am Heart J. 2009 Feb;157(2):278-84

Authors: Bonds DE, Hogan PE, Bertoni AG, Chen H, Clinch CR, Hiott AE, Rosenberger EL, Goff DC

BACKGROUND: Although high blood pressure is associated with significant morbidity and mortality, the proportion reaching the goal blood pressures as outlined in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, Treatment of High Blood Pressure (JNC 7) is low. We conducted a randomized trial in primary care practices of a multifactorial intervention targeted to improve providers' adherence to hypertension guidelines. METHOD: A total of 61 primary care practices in North Carolina were randomized to receive either a multifactorial intervention (guideline dissemination via a continuing medical education session, academic detailing sessions, audit and feedback on preintervention rates of adherence, and automated blood pressure machines) or an attention control of similar magnitude but targeted at a different guideline. Outcomes were determined through review of patient charts conducted by an independent masked quality assurance organization. RESULTS: We found no difference between the 2 groups in any of the adherence measures including no difference in the percentage of patients at goal (intervention 49.2%, control 50.6%), with undiagnosed hypertension (18.1% vs 13.6%), average systolic (126 vs 125.1 mm Hg), or diastolic blood pressure (73.1 vs 73.4 mm Hg). Similarly, there was no difference in provider adherence to treatment recommendations (use of thiazide-type diuretic as first-line therapy: 32% vs 29.5%; use of 2-drug therapy in stage 2 hypertension: 11.3% vs 10.4%). CONCLUSION: An intensive, multifactorial intervention did not improve adherence to national hypertension guidelines among community-based primary care. Efforts should be focused on other types of interventions to improve rates of control of hypertension.

PMID: 19185634 [PubMed - in process]

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