139-481 / National Disease Management Guidelines Programme (NDMG-Programme)

Germany
GOP Information  
 
Organisation sharing the GOP
Related practices from PaSQ database
Agency for Quality in Medicine (AQuMed)

Topic

Clinical guidelines or pathways
Quality indicators
Category
Education in Patient Safety
Documentation
GOP Description
 
Implementation level
National
Clinical settings
NDMGs are to be implemented in ambulatory care, hospitals and longterm care. The settings depend on the individual guideline, however primary care is a major focus as the guidelines target prevalent chronic diseases.

The guidelines are meant to be implemented as widely as possible in these facilities; implementation is voluntary.
Objectives
To promote effective delivery of health and disability services within the framework of disease management in Germany, based on best available evidence from research and practice.
Population
Clinicians working in the health care sector (physicians, nurses, therapists), patients and their families, health care adminstrators, general public
Methods
 
Methodology
The development and maintenance of the guidelines are coordinated by AquMed in collaboration with the Guidelines Commission of the Association of the Scientific Medical Societies in Germany. The individual guideline groups are further made up of experts from the relevant scientific medical societies, experts representing other professional groups (nurses, pharmacists, physiotherapists etc) and patient representatives.

Process steps in the development of an NDMG are:
- topic selection and prioritisation
- development of the draft guideline and formulation of recommendations according to a standardized methodology
- formal consensus process to finalize the guideline’s recommendations
- external review of the guideline
-finalization of the guideline and online publication
-development of a patient version and implementation tools from the guideline
-development of quality indicators from the guideline recommendations
-dissemination and implementation of the guideline
Timeframe implementation
Average timeframe for guideline development: 3,5 years
Implementation tools available
For each guideline the following implementation tools are developed:
- short version & pocket version
- patient version (“patient guideline”)
- supplementary tools (e.g. checklists)
- quality indicators which are developed from the guideline’s recommendations
- software app
- CME based on the guideline
Implementation cost
Duration and costs of NDMG development process:

Example: NDMG for Diabetic Neuropathy in Adults
Duration of development: 244 weeks
Material and staff costs: approx. 195.365 EUR

Example: NDMG for Heart Failure
Duration of development: 157 weeks
Material and staff costs: approx. 138.535 EUR
Results
 
Method used to measure the results
The most important components of the evaluation process are guideline-based quality indicators. Suitable quality indicators are derived by AquMed from the NDMG recommendations in collaboration with experts. The use of the indicators to evaluate adherence to the guidelines and an improvement of patient outcomes e.g. within Disease Management Programmes or the German nation-wide quality assurance programme (e.g. hospital-benchmarking system) is encouraged.

Until now the evaluation of the NDMGs has not been in the direct scope of responsibilities of AquMed but projects to evaluate some of the NDMGs regionally by AquMed are in planning .
Results
Results from the evaluation of ambulatory Disease Management Programs, which integrate the recommendations from NDMGs, have shown positive results in terms of changes in medical outcomes (Stock et al. The Commonwealth Fund 2011;24(1560)).
Analysis of the results
Generally studies have shown that evidence-based clinical guidelines can be effective in improving the process and structure of care. The effects of guidelines on health outcomes have been studied less and data are less convincing (Lugtenberg et al. Qual Saf Health Care 2009;18:385–392)
Implementation barriers
 
Did you find implementation barriers?
Yes
Please describe implementation barriers
A barrier in the development process is that it is often difficult to reach consensus when formulating recommendations and this can delay the development of a guideline.

The development and maintenance of a clinical guideline are resource-intensive (esp. staff costs for the coordinating institution).

A further barrier to implementation is that there are still scepticism and limited acceptance in the medical community about clinical practice guidelines.
Describe the strategies used to overcome the barriers (If needed)
Raising awareness about the importance of guidelines and capacity building in evidence-based medicine.
Other information
 
Other information about the GOP that you would like to add (Link or attached document)
There is no specified text here
64_127_GOP_nvl-methode-4.aufl-engl.pdf
Contact information
 
Name: Carmen Khan, Consultant (Internal Medicine)
Position/function: Senior Research Scientist
Department: Evidence-based medicine and guidelines
Organisation: German Agency for Quality in Medicine (AQuMed / AEZQ)
City: Berlin
Country: Germany
Region: Berlin
E-mail: nvl@azq.de
Phone: 00493040052501
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