Skip to main content
SpringerLink
Log in

Evidenzbasierte Methodik in der Leitlinienentwicklung

Development of evidence-based clinical practice guidelines: a model project integrating external evidence and clinical expertise

Integration von externer Evidenz und klinischer Expertise

  • Standorte
  • Published:
Medizinische Klinik Aims and scope Submit manuscript

Zusammenfassung

□ Hintergrund

Nachdem evidenzbasierte Leitlinien international schon seit einigen Jahren eingesetzt werden, gewinnen sie auch in Deutschland zunehmend an Bedeutung.

□ Eigene Untersuchungen

Am Institut für Gesundheitsökonomie und klinische Epidemiologie in Köln wurde ein weitgehend standardisierter Prozeß für die Entwicklung von evidenzbasierten Leitlinien ausgearbeitet. Dieser ist so angelegt, daß Reproduzierbarkeit, Validität und Praktikabilität von Leitlinien gesichert werden: Evidenz aus Forschungsergebnissen (externe Evidenz) wird systematisch gesammelt und entsprechend den Kriterien der Agency of Health Care Policy Research (AHCPR) bewertet. Durch Kooperation mit klinischen Experten („clinical judgement”) wird ihre Praktikabilität hergestellt. Auch die Verbesserung der Akzeptanz durch Anwender und Patienten soll erreicht werden.

□ Schlußfolgerung

Evidenzbasierte Leitlinien sind ein auf rationaler Grundlage entwickeltes Instrument. Dieses erscheint geeignet, medizinische Entscheidungsprozesse zu unterstützen. Das wird am Beispiel der Erstellung einer evidenzbasierten Leitlinie zur Adipositastherapie erläutert.

Abstract

□ Background

Internationally, evidence-based clinical practice guidelines have been established for several years. In Germany, they are now gaining increasing importance.

□ Own studies

The Institute of Health Economics and Clinical Epidemiology at the University of Cologne has developed a mostly standardized process for evidence-based guideline development. This process has been implemented in such a way that reproducibility, validity and practicability of guidelines can be assured: evidence from research (external evidence) has been searched and evaluated according to the criteria of the Agency of Health Care Policy and Research (AHCPR). Through cooperation with clinical experts, this evidence has been transferred into practicable recommendations. In addition, acceptance of guideline users and patients was improved by applying this method.

□ Conclusion

Evidence-based guidelines are considered as an appropriate tool to assist medical decision-making of all stakeholders involved. The process will be demonstrated developing an evidence-based guideline for obesity treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Ärztliche Zentralstelle Qualitätssicherung: Checkliste „Methodische Qualität von Leitlinien”, 1. Version. Dtsch Ärztblatt 1998;95:1838–40.

    Google Scholar 

  2. Bennett KJ, Sackett DL, Haynes RB, et al. A controlled trial of teaching critical appraisal f the clinical literature to medical students. JAMA 1987;257:2451–4.

    Article  PubMed  CAS  Google Scholar 

  3. Best Evidence. Twice yearly electronic publication on diskette and CD-ROM. Philadelphia: American College of Physicians, 1997.

    Google Scholar 

  4. Bundesärztekammer, Kassenärztliche Bundesvereinigung. Beurteilungskriterien für Leitlinien in der medizinischen Versorgung. Dtsch Ärztbl 1997;94:1754–5.

    Google Scholar 

  5. Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J 1979;121:1193–254.

    Google Scholar 

  6. Cluzeau F, Littlejohns P, Grimshaw J, et al., Appraisal instrument for clinical guidelines. London: St. George’s Hospital Medical School, 1997.

    Google Scholar 

  7. Cochrane Library London, BMJ Publishing Group. Quarterly publication available on disk and CD-ROM from the BMJ Publishing Group, American College of Physicians, Australian Medical Association, Canadian Medical Association Publications, and Medical Association of South Africa. London: Update Software, 1997.

    Google Scholar 

  8. Field MJ, Lohr KN. Clinical practice guidelines. Washington: National Academy Press, 1990.

    Google Scholar 

  9. Gerlach FM, Beyer M, Szecsenyi J, et al. et al. Leitlinien in Klinik und Praxis. Dtsch Ärztebl 1998;95:1014–21.

    Google Scholar 

  10. McKibbon KA, Haynes RB, Dilks CJ. How good are clinical Medline searchers? A comparative study of clinical end-user and librarian searches. Comput Biomed Res 1990;23:583–93.

    Article  PubMed  CAS  Google Scholar 

  11. Lauterbach KW, Lubecki P, Oesingmann U, et al. Konzept eines Clearingverfahrens für Leitlinien in Deutschland. Z Ärztl Fortbild Qual Sich 1997;91:283–8.

    CAS  Google Scholar 

  12. Lowe HJ, Barnett OG. Understanding and using the medical subject headings vocabulary to perform literature searches. JAMA 1994;271:1103–8.

    Article  PubMed  CAS  Google Scholar 

  13. Mühlhauser I, Berger M. Surrogat-Marker: Trugschlüsse. Dtsch Ärztebl 1996;93:3280–3.

    Google Scholar 

  14. Sackett DL, Haynes, RB, Guyatt GH, et al. Clinical epidemiology — a basic science for clinical medicine. Boston: Little, Brown & Co, 1991:366.

    Google Scholar 

  15. Sacks HS, Berrier J, Reitman D, et al. Meta-analyses of randomized controlled trials. N Engl J Med 1997; 316:450–5.

    Article  Google Scholar 

  16. Scottish Intercollegiate Guidelines Network: Obesity in Scotland. Integrating prevention with weight management. A national clinical guideline recommended for use in Scotland. Edinburgh: SIGN, 1996.

    Google Scholar 

  17. US-Agency for Health Care Policy and Research. Acute pain management: Operative or medical procedure and trauma. Rockville: AHCPR Publication, 1992.

    Google Scholar 

  18. US-Preventive Services Task Force. Screening for adolescent idiopathic skoliosis: Review article. JAMA 1993;269:2667–72.

    Article  Google Scholar 

  19. Woolf SH, Battista RN, Anderson GM, et al. Assessing the clinical effectiveness of preventive maneuvers: analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations. J Clin Epidemiol 1990;43:891–905.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut für Gesundheitsökonomie und Klinische Epidemiologie (IGKE) der Universität, Gleueler Straße 176-178, D-50935, Köln, Deutschland

    Karl W. Lauterbach

Authors
  1. Sibylle Steiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karl W. Lauterbach
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karl W. Lauterbach.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Steiner, S., Lauterbach, K.W. Evidenzbasierte Methodik in der Leitlinienentwicklung. Med Klin 94, 643–647 (1999). https://doi.org/10.1007/BF03045007

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03045007

Schlüsselwörter

Key words

Search

Navigation