gms | German Medical Science

Introduction: Evidence-based clinical guidelines play an important role in health care and can be a valuable source for quality indicators (QI). However, the link between guidelines and QI is often neglected. International methodological standards for the development of guideline-based QI are lacking. In context of a broader research project aiming at the development of an evidence and consensus based German methodological standard for guideline-based QI, we undertook an international qualitative study to get insights into experiences of guideline authors with the QI development process.

Methods: Interviewees from international guideline-organisations developing guideline-based QI were selected using purposive sampling with a maximum variation of health care settings. An interview guide was developed based on the “Reporting Standards for Guideline-based Performance Measures published by the Guidelines International Network (G-I-N) with a focus on methods, experiences and facilitating/hindering factors in the different QI development stages. Interviews were analysed using qualitative content analysis.

Results: Fifteen semi-structured interviews were carried out with methodologists and clinicians from eight organisations in six European/North American countries. A variety of approaches exist regarding timing and organisation of guideline-based QI development. A programmatic approach with links to existing quality improvement strategies and involvement of various stakeholders with clinical and methodological knowledge appeared as facilitating factors for developing and implementing guideline-based QI. Further facilitating factors included a clear methodology with QI training in the developing team and a shared understanding of the intended QI use. Patient participation and direct patient relevance were inconsistently considered important. Measuring qualitative aspects and individualized care poses current challenges.

Conclusion: Our results suggest that the development of guideline-based QI can succeed either parallel to or following the guideline process but requires adequate planning and instruction. Patient participation and patient relevance as well as qualitative measures are areas for further development and harmonization. Strategic partnerships seem key for implementation.