Qualität t und Evidenz in der Ernährungsmedizin. - Facts & Fantasies

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Susanne Richter
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1 Qualität t und Evidenz in der Ernährungsmedizin - Facts & Fantasies

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3 Qualität t und Evidenz in der Ernährungsmedizin - Facts: Evidenz & Qualität t = Thema in (fast) allen Gesundheitssyst. Basic Science Discovery Best Practice Definition (Guideline) Evidence from Clinical Research Intervention approved for Benefit Catalogue & Best Practice CPGs accepted by Providers State of the Art Healthcare Medical Knowledge Lost in Translation? Individual Outcome Source: Schwartz K, Vilquin JT. Building the translational highway: Toward new partnerships between academia and the private 3sector. Nature Medicine. 2003;9:493-5.(modified)

Best Practice CPGs accepted by Providers State of the Art Healthcare Medical Knowledge Lost in Translation?

4 EM zwischen Qualität t & Ökonomie - Wo geht die Reise hin? Facts: Leitlinien - Indikatoren - QM - HTA - Qualitätsdarlegung tsdarlegung Entwicklung, Verbreitung, Evaluation von Leitlinien & Qualitätsindikatoren Einführung von Qualitätsmanagement in Gesundheitseinrichtungen Anwendung von Evidenzbas. Medizin / Health Technology Assessment Aufbau von Gesundheitsinfo-Systemen für Selbstkontrolle / Qualitätsvergleich Empfehlungen des Europarates zur Qualitätsförderung im Gesundheitswesen 4 Europarat Rec. No. R (97) 17

Qualitätsindikatoren Einführung von Qualitätsmanagement in Gesundheitseinrichtungen Anwendung von Evidenzbas.

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6 6 Ärztliche Leitlinien + PatientenLeitlinien Grundlage gemeinsamer Entscheidungsfindung

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8 Ernährungsmedizin zwischen Qualität t und Ökonomie - Wo geht die Reise hin? Facts: Explizite Abwägung von Nutzen (E&Q) und Kosten Comparative health care benefits? Higher Similar Lower Compar- ative resource use? Higher Similar Lower Maybe Prioritised reserve list Yes Phased implementation Yes Implement immediately Maybe? Put on hold Maybe Examine further Yes Manage implementation No Do not pursue No Do not pursue Maybe Further analyse benefits & costs 8 Bandolier Evidence based Implementation. Oxford

Higher Similar Lower Maybe Prioritised reserve list Yes Phased implementation Yes Implement immediately Maybe?

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10 Bildquelle: Peking Univ. Centre for EbM Fantasies: Einstellung zu EbM / TQM Die Leitlinien-Realität in Deutschland versus practitioners policy makers

cn 10 Fantasies: Einstellung zu EbM / TQM

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12 LL-Nutzung durch Hausärzte in D : 60 % nutzen Leitlinien selten oder nie (KV Hessen 2001, KV Berlin 2003) Hemmende Faktoren: Routine Kosten Jurist.Impl. Kompliz.Anwdg. Formate Patientenwünsche Aktualität Widersprüchl.LL Unabh.d.Autoren Finden guter LL Bekanntheit A. Kunz, Magisterarbeit FU Berlin, Internet: % 12

Formate Patientenwünsche Aktualität Widersprüchl.LL Unabh.d.Autoren Finden guter LL Bekanntheit 0 10 20 30 40 50 60 70 A.

13 Leitlinien-basierte Behandlung in den USA 13

14 EM zwischen Qualität t & Ökonomie - Wohin geht die Reise?...zur evidenzbasierten EM in Wissenschaft, Lehre und Praxis 14

15 Evidence Guidance and Change Management - what do we know? The German Story Günter Ollenschläger, Monika Lelgemann Ärztliches Zentrum für Qualität in der Medizin - Gemeinsames Institut von BÄK & KBV - Berlin, 5. Oktober 2006 Evidence based Medicine and Clinical Practice Guidelines - Facts and Fiction A Joint Symposium of Therapeutic Guidelines Ltd, Australia and AEZQ/AQuMed, Berlin Solutions for Overcoming Barriers Actions Sell the professional profits of EbM use: : EbM = FUN!!! Think about doctor s s & patient s questions (and not the expert s) Implement Eb decision aids & feedback tools Act in concert: Implement packages of < EbM + TQM + CME + Organ.Devel Devel.. + Contracts> Defeat misuse of EbM : it s for QI not for resource limitation Enable the patient / consumer to ask for Eb health care 15

Oktober 2006 Evidence based Medicine and Clinical Practice Guidelines - Facts and Fiction A Joint Symposium of Therapeutic Guidelines Ltd, Australia and AEZQ/AQuMed, Berlin Solutions for Overcoming

16 73 Leitlinien-Organisationen - 35 Staaten AMERICA Guidelines Advisory Committee (GAC), CA Progr. in Evidence-based Care, Cancer Care Ontario (PEBC), CA Agency for Health Research and Quality (AHRQ), US National Kidney Foundation (NKF), US ASIA Prof. Develo. and Quality Assurance, DoH, (PDQA-DoH) HK-SAR Japan Council for Quality Health Care (MISC), JP ZDRAV Plus Project (ZPLUS), KZ, KG, TJ, TM, UZ HTA Unit, Ministry of Health, Malaysia, MY Ministry of Health, School of Public Health, TR EUROPE Austrian Association for Quality in Healthcare (evidence.at), AT Belgian Centre for Evidence-Based Medicine (CEBAM), BE Flemish College of General Practitioners (WVVH), BE Danish Centre for Evaluation and HTA (DACEHTA), DK Estonian Health Insurance Fund, EE Current Care; Finnish Medical Society DUODECIM FI Finnish Office for HTA (FinOHTA), FI French National Health Authority (HAS formerly ANAES), FR National Federation of Cancer Centres (FNCLCC), FR Agency for Quality in Dentistry (ZZQ), DE Agency for Quality in Medicine (ÄZQ/AQuMed), DE Association of Scientific Medical Societies (AWMF), DE Berlin Chamber of Physicians (AEKB), DE Nat.Inst. for Quality Measurement in Health Care (BQS), DE Federal Joint Committee (GBA), DE Institute for Quality and Efficiency in Healthcare (IQWIG), DE The Mental Health Commission (MHC), IE Italian Evidence-Based Medicine Group (GIMBE), IT Regional Health Agency Emilia Romagna (ASR), IT Moldovian Association of Perinatal Medicine, MD Dutch Association of Comprehensive Cancer Centres (ACCC), NL Dutch College of General Practitioners (NHG), NL Dutch Institute for Healthcare Improvement (CBO), NL Royal Dutch Society for Physical Therapy (KNGF), NL Trimbos-Inst. - NL Institute of Mental Health & Addiction, NL Directorate for Health and Social Affairs (SHdir), NO Polish Institute for Evidence Based Medicine (PIEBM), PL Center for EBM, Univ. of Lisbon School of Medicine, PL Institute for Quality in Healthcare (IQS), PT Center of Health Policies and Services, RO Nat.Inst.of Research and Development in Health, RO Slovene Guidelines Group, SI Basque Office for HTA (OSTEBA), ES Josep Laporte Library Foundation (FBJL), ES Spanish Network for Research on Guidelines (REDEGUIAS), ES National Board of Health and Welfare (Socialstyrelsen), SE Swiss Federal Office of Public Health (SFOPH), CH Clinical Epidemiology Centre (CepiC), University Hospital, CH Swiss Medical Association (FMH), CH Centre for Reviews & Dissemination, Univ.of York (CRD), GB National Institute for Clinical Excellence (NICE), GB Royal College of Nursing Institute (RCNI), GB Scottish Intercollegiate Guidelines Network (SIGN), GB Sowerby Centre f. Health Informatics, Newcastle (SCHIN), GB OCEANIA Joanna Briggs Institute (JBI), AU Nat. Health & Medical Research Council (NHMRC), AU National Institute of Clinical Studies (NICS), AU Therapeutic Guidelines Ltd (TGL) AU NZ Accident Compensation Corporation (ACC), NZ New Zealand Guidelines Group (NZGG), NZ INTERNATIONAL AGREE Research Trust (ART) World Health Organisation (WHO) European Union of Medical Specialists (UEMS) G-I-N Partner World Medical Association (WMA) G-I-N Partner

and Quality Assurance, DoH, (PDQA-DoH) HK-SAR Japan Council for Quality Health Care (MISC), JP ZDRAV Plus Project (ZPLUS), KZ, KG, TJ, TM, UZ HTA Unit, Ministry of Health, Malaysia, MY Ministry of

17 Danke für Ihre Aufmerksamkeit!!!!! Guidelines are a way to improve medical care not an end in itself patients / consumers practitioners Three main target audiences policy makers 17

in itself http://pkuebm.bjmu.edu.cn/index/5.

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