DÄ internationalArchive12/2013Influence of Supporting Feedback
LNSLNS

Implementation of guidelines into clinical practice is regarded as the main requirement for future quality assurance. Active dissemination of clinical pathways with prompt feedback, as detailed by the authors, leads to practical additions to today`s retrospectively oriented processes of quality assurance (1). A high amount of good quality guidelines with a high density of information exists. Therefore a practical way for broad implementation via flexible and case-related workflows is required (2). Guideline knowledge alone does not have a remarkable influence on the clinician´s behavior as mentioned in the study (2). Appropriate feedback loops can gain the physician’s attention to leaving the pathway recommended by guidelines.

Supporting feedback delivered by intelligent software solutions is increasingly used in clinical practice. It is obvious that the user of IT systems should always be allowed to ignore and even dismiss recommendations by the system. Deviation from the clinical guideline recommendations, however, is documented in almost all existing electronic support systems and can later be evaluated within the scope of structured quality management. Without question, close and continuous discussion about adherence to the pathway with a respected and instructing physician is of high value. However this should not lead the conclusion “either … or” but “as well as”. IT supported systems cannot replace instructing expert physicians, but should support them in in their endeavor to achieve high quality by providing of continually increasing amounts of patient-related data.

The study by Steinacher and colleagues is a step in the right direction.

DOI: 10.3238/arztebl.2013.0211a

Dr. med. Beatrice Moreno MPH, MSc
Information und Dokumentation im
Gesundheitswesen GmbH & Co. KGaA, Berlin
B.Moreno@id-berlin.de

Conflict of interest statement

The author is the scientific lead for the project “SIMPLE—Semantically Founded Implementation of Clinical Practice Guidelines,” which is funded by the German Federal Ministry of Education and Research.

1.
AHRQ: Enabling Health Care Decisionmaking through Clinical Decision Support and Knowledge Management. Evidence Report/Technology Assessment No. 203. 2012.
2.
Greiner U, Müller R, Rahm E, Ramsch J, Heller B, Löffler M:
Protocol-based medical treatment using adaptive workflows.
Methods Inf Med 2005; 44: 80–8. MEDLINE
3.
Steinacher B, Mausolff L, Gusy B: The effects of a clinical
care pathway for schizophrenia—a before and after study in 114 patients. Dtsch Arztebl Int 2012; 109(46): 788–94 VOLLTEXT
1.AHRQ: Enabling Health Care Decisionmaking through Clinical Decision Support and Knowledge Management. Evidence Report/Technology Assessment No. 203. 2012.
2.Greiner U, Müller R, Rahm E, Ramsch J, Heller B, Löffler M:
Protocol-based medical treatment using adaptive workflows.
Methods Inf Med 2005; 44: 80–8. MEDLINE
3.Steinacher B, Mausolff L, Gusy B: The effects of a clinical
care pathway for schizophrenia—a before and after study in 114 patients. Dtsch Arztebl Int 2012; 109(46): 788–94 VOLLTEXT

Info

Specialities