German guideline assessment tool

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The German Guideline Assessment Instrument ( DELBI ) is a procedure published by the Working Group of Scientific Medical Societies and the Medical Center for Quality in Medicine to review and evaluate the methodological quality of medical guidelines. DELBI was developed between 2003 and 2005 and then tested in a pilot test. DELBI was divided into eight different domains.

development

The German guideline assessment instrument was developed between 2003 and 2005 in cooperation between the Medical Center for Quality in Medicine , the Working Group of Scientific Medical Associations , and other various partners from the fields of care practice, health administration and science.

Areas of application

The German guideline assessment tool was designed to assess medical guidelines. You can use DELBI in the following situations:

On the one hand, DELBI can be used to develop new guidelines and also as a self-assessment tool to ensure that the newly developed guidelines also comply with international standards. Furthermore, DELBI can also be used to evaluate guideline recommendations before implementation. DELBI can also be used in advanced training courses, for example to make it easier for medical staff and doctors to critically assess situations. In addition, DELBI can be a decision-making aid when it comes to which guidelines are to be implemented in practice. In general, DELBI can be used to evaluate new guidelines, existing guidelines and also to update existing health care guidelines.

Domains

DELBI comprises eight so-called domains with a total of 34 questions. There are four possible answers for each question with the numbers one (does not apply at all) to four (applies without restriction). While DELBI had seven so-called domains when it was published in 2005, an eighth domain was added in 2007.

Domain 1: scope and purpose

The first domain deals with the overall goal of a guideline, with the first domain addressing the medical problems and issues as well as the patient audience. There are the following three criteria in the domain of scope and purpose: On the one hand, it is assessed whether the guideline to be assessed is described in a differentiated manner. Furthermore, one analyzes whether the medical questions and problems treated are described differently in the guideline. In addition, the uniqueness of the patients for whom the guideline to be assessed should apply is included in the first domain.

Domain 2: stakeholder involvement

The second domain deals with the degree to which the guideline embodies the view of the affected patients and users. The second domain comprises the following four criteria: It is analyzed whether the developer group of the guideline to be assessed has included the members of all relevant professional groups in the guideline. In addition, it is assessed whether and to what extent the preferences and views of the patients were determined. Furthermore, it is analyzed whether the user target group of the guideline has been defined. Finally, the second domain also deals with whether the guideline to be assessed has been tested by members of the user target group as part of a pilot study.

Domain 3: Methodological accuracy of guideline development

The third domain deals with the process by which the data was collected and ultimately evaluated. In addition, the third domain also deals with the methods with which the recommendations were drawn up. The third domain comprises the following assessment criteria: On the one hand, the third domain deals with whether systematic methods were used in the search for the evidence for the guideline. Second, it is checked whether the selection criteria of the evidence for the guideline to be assessed are clearly described. Furthermore, it is analyzed whether the methods for formulating the recommendations were clearly described. It is also checked to what extent the formulation of the recommendations takes into account the risks and side effects as well as the health benefits. In addition, the extent to which the connection between the evidence and the recommendations is explicitly presented is analyzed. In addition, one checks whether the guideline to be assessed has been reviewed by external experts before publication. Finally, a check is made in the third domain to see whether an update procedure has been specified for the guideline to be assessed.

Domain 4: clarity and design

The fourth domain deals with the format and comprehensibility of the guideline to be assessed. The fourth domain includes the following evaluation criteria: On the one hand, it is checked whether the recommendations mentioned in the guideline to be evaluated are clear and specific. In addition, it is also analyzed whether the various options for action for the supply problem were presented. It is also assessed whether the key recommendations of the guideline to be assessed are easy to identify. Finally, one also checks whether materials or instruments are available that support the application of the guideline to be assessed.

Domain 5: Applicability

The fifth domain relates to the possible organizational, behavioral and cost impacts of the application of the guidelines. The fifth domain therefore deals with the following three criteria: On the one hand, the fifth domain deals with whether the application of the recommendation in medical institutions or on a structural level is too complicated and thus prevents or complicates the implementation of the guideline. Second, the financial impact and resource consumption that would follow a new recommendation are discussed and the cost-benefit is weighed. Finally, the fifth domain determines metrics with which the benefit of the recommendation can be determined. The application of the guidelines in practice is checked and the effects on the patient's individual therapeutic success and the direct impact on the patients affected by the guidelines are analyzed.

Domain 6: Editorial independence

The sixth domain deals with the independence of the recommendations as well as with the disclosure of possible conflicts of interest on the part of the developer group of the guideline in question. The sixth domain deals with two points: Any support and funding of the guideline group that comes from external sources must be explicitly named and it must also be demonstrated that this has not resulted in any influence on the guidelines by these external sources. In addition, the conflict of interest that exists in a guideline development group over a new guideline should be presented, for example in a guideline report.

Domain 7: Applicability in the German health system

The seventh domain deals with the additional quality criteria of the guideline which is potentially used in the German health system. The seventh domain deals with the following six criteria: On the one hand, the seventh domain deals with which medical areas the guideline affects and covers through its specific areas and goals. The guideline also states which measures are necessary and sensible and which are superfluous. A guideline should also be presented in a comprehensible manner, for example by providing a clearly formulated problem in a clinical situation with an understandable answer. Another point with which the seventh. The domain concerned is that when a new guideline is published, reference is made to this new guideline in as many ways as possible and that the guideline can be viewed in as many ways as possible. In addition, the seventh domain deals with concepts with which new guidelines can best be integrated into the existing medical structures so that patients can quickly benefit from the new guideline, for example through further training of doctors and medical staff. Finally, the seventh domain regulates the disclosure of the methodological procedure of the guideline author group. A guideline report should explain why a recommendation was rejected or included in the guidelines.

Domain 8: Methodological accuracy of guideline development using existing guidelines

The eighth domain deals with the procedure with which existing guidelines are assessed, collected and incorporated when a new guideline is created. The eighth domain deals with five points. Firstly, the search for guidelines should be systematic and transparent, and a search strategy should be described in detail as to how existing guidelines can be found. Second, it should be explained why a particular guideline is a source guideline, which is used as a source of evidence. When a new recommendation is derived from a source guideline, the quality of the source guideline should be checked. In addition, the eighth domain also addresses the fact that source guidelines that are no longer up-to-date should be updated so that there is again evidence for the source guideline. Finally, the eighth domain regulates that when creating a new guideline that uses an existing guideline, it is necessary to clearly identify the extent to which the new recommendation corresponds to the existing recommendation and why something has been changed or retained in the source guideline.

Effectiveness and quality

The information from the Medical Center for Quality in Medicine regards it as evidence that the usefulness and effectiveness of guidelines strongly depend on the quality of the guideline. Therefore, the quality criteria that a high quality guideline should meet are defined uniformly internationally. In addition, it is scientifically proven that good guidelines have a positive influence on the quality of results and processes in the health care system.

literature

  • Consensus paper by BÄK, KBV and AWMF, Z Arztl Fortbild Qualitätssich (Ed.): Assessment of clinical parameters of quality management - quality criteria and indicators in health care , 2002.
  • Medical Center for Quality in Medicine (Ed.), Guideline Clearing Report , 2005.
  • Authors: Ollenschläger G., Thomeczek C., Thalau F., Heymans L., Thole H., Trapp H., Singer S., Lelgemann M .: Medical guidelines in Germany . Ed .: Z Arztl Advanced Training Quality Assurance, 2005.
  • Authors: Schubert I., Lelgemann M., Kirchner H., von Ferber C., von Ferber L., Ollenschläger G .: Handbook for the development of regional guidelines . Ed .: Z Artzl Fortbild Qualitätssich, 2005.
  • Authors: Beyer M., Geraedte M., Gerlach FM, Güllch M., Kopp I., Lelgemann M., Ollenschläger G., Selbmann H.-K., Thole H., Follmann M., Holzmann N., Langer T. ., Nothacker M., Siering U., Weinbrenner S., Wieland A .: German instrument for methodological guideline assessment (DELBI) version 2005/2006 + domain 8 (2008) . Ed .: AWMF and ÄZQ.

Individual evidence

  1. ^ SupplyLeitlinien.de . Retrieved December 19, 2017 .
  2. ↑ VersorgunsLeitlinien.de. Retrieved December 19, 2017 .
  3. ↑ DELBI (German Guideline Assessment Instrument) - ÄZQ. Retrieved December 19, 2017 .
  4. ↑ DELBI - Information about the German guideline assessment tool . In: reimbursement.info . ( reimbursement.info [accessed December 19, 2017]).
  5. ↑ Introduction - ÄZQ. Retrieved December 19, 2017 .
  6. ↑ Introduction - ÄZQ. Retrieved December 19, 2017 .
  7. ↑ Introduction - ÄZQ. Retrieved December 19, 2017 .
  8. ↑ DELBI (German Guideline Assessment Instrument) - ÄZQ. Retrieved December 19, 2017 .
  9. ↑ a b c d e f g h i Beyer M., Geraedte M., Gerlach FM, Güllch M., Kopp I., Lelgemann M., Ollenschläger G., Selbmann H.-K., Thole H., Follmann M ., Holzmann N., Langer T., Nothacker M., Siering U., Weinbrenner S., Wieland A .: German instrument for methodological guideline assessment (DELBI) version 2005/2006 + domain 8 (2008) . Ed .: AWMF and ÄZQ.
  10. ↑ DELBI - Information about the German guideline assessment tool . In: reimbursement.info . ( reimbursement.info [accessed December 19, 2017]).
  11. ↑ 1. Scope - ÄZQ. Retrieved December 19, 2017 .
  12. ↑ 2. Participation - ÄZQ. Retrieved December 19, 2017 .
  13. ↑ 3. Methodology - ÄZQ. Retrieved December 19, 2017 .
  14. ↑ 4. Clarity - ÄZQ. Retrieved December 19, 2017 .
  15. ↑ 5. Applicability - ÄZQ. Retrieved December 19, 2017 .
  16. ↑ 6. Independence - ÄZQ. Retrieved December 19, 2017 .
  17. ↑ 7. German Health Service - ÄZQ. Retrieved December 19, 2017 .
  18. ↑ 8. Adaptation - ÄZQ. Retrieved December 19, 2017 .
  19. ↑ Effectiveness and quality - ÄZQ. Retrieved December 19, 2017 .
  20. ↑ Effectiveness and quality - ÄZQ. Retrieved December 19, 2017 .