Considerations on the Improved Integration of Medical Guidelines into Routine Clinical Practice – a Review and Concept Proposal

Medical guidelines have become established as the standard for the comprehensive synopsis of all available information (scientific trials, expert opinion) on diagnosis and treatment recommendations. The transfer of guidelines to clinical practice and subsequent monitoring has however proven difficult. In particular the potential interaction between guideline developers and guideline users has not been fully utilised. This review article analyses the status quo and existing methodological and technical information solutions supporting the guideline life cycle. It is shown that there are numerous innovative developments that in isolation do not provide comprehensive support. The vision of the "Living Guidelines 2.0" is therefore presented. This outlines the merging of guideline development and implementation on the basis of clinical pathways and guideline-based quality control, and building on this, the generation of information for guideline development and research.

[1]  J M Grimshaw,et al.  Effectiveness and efficiency of guideline dissemination and implementation strategies , 2004, International Journal of Technology Assessment in Health Care.

[2]  I. Kopp,et al.  Perspektiven der Leitlinienentwicklung und -implementation aus der Sicht der AWMF , 2010, Zeitschrift für Rheumatologie.

[3]  R. Grol,et al.  Clinical guidelines to improve patient care. , 2005, The Netherlands journal of medicine.

[4]  C. Muche-Borowski,et al.  Wie eine Leitlinie entsteht , 2011, Zeitschrift für Herz-,Thorax- und Gefäßchirurgie.

[5]  Richard N Shiffman,et al.  Building better guidelines with BRIDGE-Wiz: development and evaluation of a software assistant to promote clarity, transparency, and implementability , 2012, J. Am. Medical Informatics Assoc..

[6]  E. James,et al.  What is a clinical pathway? Development of a definition to inform the debate , 2010, BMC medicine.

[7]  Reinhard Busse,et al.  "Best Practice" im Gesundheitswesen--oder warum wir evidenzbasierte Medizin, Leitlinien und Health Technology Assessment brauchen. , 2000 .

[8]  Kris Vanhaecht,et al.  Is there still need for confusion about pathways? , 2010 .

[9]  J. Grimshaw,et al.  Potential benefits, limitations, and harms of clinical guidelines , 1999, BMJ.

[10]  H. Kirchner,et al.  Leitlinien in der Medizin – scheitern sie an der praktischen Umsetzung? , 2001, Der Internist.

[11]  Chen Qin-min.  Considerations about the , 2006 .

[12]  Britta Böckmann,et al.  Extracting and transforming clinical guidelines into pathway models for different hospital information systems , 2013, Health Inf. Sci. Syst..

[13]  R. Kreienberg,et al.  Effects of guideline adherence in primary breast cancer--a 5-year multi-center cohort study of 3976 patients. , 2010, Breast.

[14]  Katharina Kaiser,et al.  Versioning computer-interpretable guidelines: Semi-automatic modeling of 'Living Guidelines' using an information extraction method , 2009, Artif. Intell. Medicine.

[15]  C. Godfrey,et al.  Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. , 2010, International journal of evidence-based healthcare.

[16]  Birgit Jacobs.  Ableitung von klinischen Pfaden aus evidenzbasierten Leitlinien am Beispiel der Behandlung des Mammakarzinoms der Frau , 2007 .

[17]  C. Lenfant.  Shattuck lecture--clinical research to clinical practice--lost in translation? , 2003, The New England journal of medicine.

[18]  K. Vosteen,et al.  Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) , 1992, Unfallchirurgie.

[19]  Hannes Schlieter.  Ableitung von Klinischen Pfaden aus Medizinischen Leitlinien – Ein Modellbasierter Ansatz , 2012 .

[20]  Thorsten Kühn,et al.  Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms , 2013, Senologie.