141 Requirements And Infrastructure For The Evaluation Of Implementation And Use Of Clinical Practice Guidelines In Gp Offices

S. Hölzer, J. Dudeck , T. Karg
Background: The documentation of patient characteristics, procedures of care and follow-up of the disease plays an important role in monitoring quality of care and supporting clinical research. Clinical Practice Guidelines (CPGs) have been proposed as a way to assist physicians in the clinical decision-making process because the rapidly increasing volume and complexity of medical knowledge makes it difficult for physicians to incorporate research data into their daily practice. In order to evaluate the use of CPGs and their positive implications towards quality of care, some closer reflections are needed to meet the special requirements.
Methods: The paradigm of a patient-oriented, treatment accompanying documentation includes the collection of clinical relevant process and outcome data which describes all the dimensions of quality of patient care. Therefore we have developed in co-operation with several German Medical Societies so called Patient Care Evaluation Studies. This approach includes a uniform disease specific documentation, statistical analysis, as well as an infrastructure for interpretation and publication of results by using current methods of information technology and biometrics.
Results: The content of the documentation together with standards of care such as Clinical Practice Guidelines should be parallel developed in interdisciplinary co-operation. The amount of data and concomitant costs are increasing the more detailed data is needed. Our experiences are indicating that it is far more difficult to get continuous, structured information from the ambulatory care than from the hospital setting. This way, some measurements to evaluate patient care are doomed to fail on a basic level.
By defining and implementing standards for communication between computerised systems in the health care domain (e.g. Behandlungsdatenträger and eXtensible Mark-up Language), we are able to reach an Information Sweet Spot which adds most value by controlling the amount and costs of data management. The availability of structured information in electronic patient records of hospital information systems and GP computer systems are facilitating this process. These efforts will drastically reduce the work load for the treating GP. The GP holds a key position concerning communication and opening access to further diagnostic and therapeutic procedures, especially in the management of complex diseases, such as malignant tumours etc., which require a high level of interdisciplinary co-operation. This way, he has strong influence on the appropriateness and punctuality of patient care.
141 Requirements and Infrastructure for the Evaluation of Implementation and Use of Clinical Practice Guidelines in GP Offices