العنوان البديل: Intensivmedizinische Qualitätsindikatoren für Deutschland – vierte Auflage 2022. (German)

المؤلفون: Kumpf, Oliver, Assenheimer, Markus, Bloos, Frank, Brauchle, Maria, Braun, Jan-Peter, Brinkmann, Alexander, Czorlich, Patrick, Dame, Christof, Dubb, Rolf, Gahn, Georg, Greim, Clemens-A., Gruber, Bernd, Habermehl, Hilmar, Herting, Egbert, Kaltwasser, Arnold, Krotsetis, Sabine, Kruger, Bastian, Markewitz, Andreas, Marx, Gernot, Muhl, Elke

المصدر: GMS German Medical Science; 2023, Vol. 21, p1-27, 27p

مصطلحات موضوعية: CRITICAL care medicine, INTENSIVE care units, ARTIFICIAL respiration

مصطلحات جغرافية: GERMANY

الملخص (بالإنجليزية): The measurement of quality indicators supports quality improvement initiatives. The German Interdisciplinary Society of Intensive Care Medicine (DIVI) has published quality indicators for intensive care medicine for the fourth time now. After a scheduled evaluation after three years, changes in several indicators were made. Other indicators were not changed or only minimally. The focus remained strongly on relevant treatment processes like management of analgesia and sedation, mechanical ventilation and weaning, and infections in the ICU. Another focus was communication inside the ICU. The number of 1 0 i ndicators remained the same. The development method was more structured and transparency was increased by adding new features like evidence levels or author contribution and potential conflicts of interest. These quality indicators should be used in the peer review in intensive care, a method endorsed by the DIVI. Other forms of measurement and evaluation are also reasonable, for example in quality management. This fourth edition of the quality indicators will be updated in the future to reflect the recently published recommendations on the structure of intensive care units by the DIVI. [ABSTRACT FROM AUTHOR]

Abstract (German): Die Messung relevanter Qualitätsindikatoren unterstützt Initiativen zur Qualitätsverbesserung. Die Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI) hat die intensivmedizinischen Qualitätsindikatoren nun zum vierten Mal publiziert. Sie wurden nach drei Jahren überarbeitet und einige Indikatoren wurden angepasst. Andere Indikatoren erfuhren keine oder nur minimale Änderungen. Der Fokus besteht weiter auf relevanten Behandlungsprozessen wie Management von Analgesie und Sedierung, Beatmung und Weaning sowie Infektionen auf der Intensivstation. Die Gesamtzahl von zehn Indikatoren blieb bestehen. Die Entwicklung der Indikatoren erfolgte in der neuen Version nach einem anderen Prozess. Die Transparenz wurde durch Erwähnung der Einzelbeiträge der Autoren sowie auch potenzieller Interessenkonflikte erhöht. Die Anwendung der Qualitätsindikatoren im Peer-Review-Prozess der DIVI ist weiter wesentlicher Schwerpunkt. Aber auch andere Anwendungen, z.B. im Qualitätsmanagement, sind sinnvoll. Diese vierte Auflage der Qualitätsindikatoren wird noch einmal aktualisiert, um die kürzlich veröffentlichten Empfehlungen der DIVI zur Struktur der Intensivstationen zu berücksichtigen. [ABSTRACT FROM AUTHOR]

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العنوان البديل: Die zukünftige Entwicklung intensivmedizinischer Qualitätsindikatoren – ein Methodenpapier. (German)

المؤلفون: Kumpf, Oliver, Nothacker, Monika, Braun, Jan, Muhl, Elke

المصدر: GMS German Medical Science; 2020, Vol. 18, p1-21, 21p

مصطلحات موضوعية: CRITICAL care medicine, GOAL (Psychology), MEDICAL societies, KNOWLEDGE management, COOPERATIVE research

مصطلحات جغرافية: GERMANY

الملخص (بالإنجليزية): Introduction: Medical quality indicators (QI) are important tools in the evaluation of medical quality. Their development is subject to specific methodological requirements, which include practical applicability. This is especially true for intensive care medicine with its complex processes and their interactions. This methods paper presents the status quo and shows necessary methodological developments for intensive care QI. For this purpose, a cooperation with the Association of the Scientific Medical Societies' Institute for Medical Knowledge Management (AWMF-IMWi) was established. Methodology: Review of published German manuals for QI development from guidelines and narrative review of quality indicators with a focus on evidence and consensus-based guideline recommendations. Future methodological adaptations of indicator development for improved operationalization, measurability and pilot testing are presented, and a development process is proposed. Results: The development of intensive care quality indicators in Germany is based on an established process. In the future, additional evaluation criteria (QUALIFY criteria) will be applied to assess the evidence base. In addition, a continuous exchange between the national steering committee of the DIVI responsible for QI development and guideline development groups involved in intensive care medicine is planned. Conclusion: Intensive care quality indicators will have to meet improved methodological requirements in the future by means of an improved development process. Future QI development is intended to improve the structure of the development process, with a focus on scientific evidence and a link to guideline projects. This is intended to achieve the goal of a broad application of QI and to further evaluate its relevance for patient outcome and performance of institutions. [ABSTRACT FROM AUTHOR]

Abstract (German): Einleitung: Medizinische Qualitätsindikatoren (QI) sind wichtige Instrumente bei der Bewertung der medizinischen Qualität. Ihre Entwicklung unterliegt spezifischen methodischen Anforderungen, einschließlich der praktischen Anwendbarkeit. Dies gilt insbesondere für die Intensivmedizin mit ihren komplexen Prozessen und deren Wechselwirkungen. Dieses Methodenpapier präsentiert den Status quo und zeigt die notwendigen methodischen Entwicklungen für die Intensivpflege-QI. Zu diesem Zweck wurde eine Kooperation mit dem Institut für medizinisches Wissensmanagement der Vereinigung der Wissenschaftlich-Medizinischen Gesellschaften (AWMF-IMWi) eingerichtet. Methodik: Überprüfung veröffentlichter deutscher Handbücher zur QI-Entwicklung anhand von Leitlinien und narrative Überprüfung von Qualitätsindikatoren mit Schwerpunkt auf Evidenz und konsensbasierten Leitlinienempfehlungen. Zukünftige methodische Anpassungen der Indikatorentwicklung zur Verbesserung der Operationalisierung, Messbarkeit und Pilotversuche werden vorgestellt und ein Entwicklungsprozess vorgeschlagen. Ergebnisse: Die Entwicklung von Intensivqualitätsindikatoren in Deutschland basiert auf einem etablierten Prozess. In Zukunft werden zusätzliche Bewertungskriterien (QUALIFY-Kriterien) angewendet, um die Evidenzbasis zu bewerten. Darüber hinaus ist ein kontinuierlicher Austausch zwischen dem für die QI-Entwicklung zuständigen nationalen Lenkungsausschuss des DIVI und den an der Intensivmedizin beteiligten Leitlinienentwicklungsgruppen geplant. Fazit: Intensivqualitätsindikatoren müssen künftig durch einen verbesserten Entwicklungsprozess verbesserten methodischen Anforderungen gerecht werden. Die zukünftige QI-Entwicklung soll die Struktur des Entwicklungsprozesses verbessern, wobei der Schwerpunkt auf wissenschaftlichen Erkenntnissen und einer Verknüpfung mit Leitlinienprojekten liegt. Damit soll das Ziel einer breiten Anwendung von QI erreicht und dessen Relevanz für das Patientenergebnis und die Leistung von Einrichtungen weiter bewertet werden. [ABSTRACT FROM AUTHOR]

: Copyright of GMS German Medical Science is the property of German Medical Science Publishing House gGmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Graw, Jan A., Spies, Claudia D., Wernecke, Klaus-D., Braun, Jan-Peter

المصدر: PLoS ONE; Oct2012, Vol. 7 Issue 10, Special section p1-8, 8p

مصطلحات موضوعية: DECISION making, CRITICAL care medicine, ADVANCE directives (Medical care), INTENSIVE care units, MEDICAL care

مصطلحات جغرافية: GERMANY

مستخلص: Introduction: End-of-life-decisions (EOLD) have become an important part of modern intensive care medicine. With increasing therapeutic possibilities on the one hand and many ICU-patients lacking decision making capacity or an advance directive on the other the decision making process is a major challenge on the intensive care unit (ICU). Currently, data are poor on factors associated with EOLD in Germany. In 2009, a new law on advance directives binding physicians and the patients surrogate decision makers was enacted in Germany. So far it is unknown if this law influenced proceedings of EOLD making on the ICU. Methods: A retrospective analysis was conducted on all deceased patients (n = 224) in a 22-bed surgical ICU of a German university medical center from 08/2008 to 09/2010. Patient characteristics were compared between patients with an EOLD and those without an EOLD. Patients with an EOLD admitted before and after change of legislation were compared with respect to frequencies of EOLD performance as well as advance directive rates. Results: In total, 166 (74.1%) of deaths occurred after an EOLD. Compared to patients without an EOLD, comorbidities, ICU severity scores, and organ replacement technology did not differ significantly. EOLDs were shared within the caregiverteam and with the patients surrogate decision makers. After law enacting, no differences in EOLD performance or frequency of advance directives (8.9% vs. 9.9%; p = 0.807) were observed except an increase of documentation efforts associated with EOLDs (18.7% vs. 43.6%; p<0.001). Conclusions: In our ICU EOLD proceedings were performed patient-individually. But EOLDs follow a standard of shared decision making within the caregiverteam and the patients surrogate decision makers. Enacting a law on advance directives has not affected the decision making-process in EOLDs nor has it affected populations advance care planning habits. However, it has led to increased EOLD-associated documentation on the ICU. [ABSTRACT FROM AUTHOR]

: Copyright of PLoS ONE is the property of Public Library of Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Kumpf, Oliver¹ (AUTHOR), Braun, Jan-Peter² (AUTHOR), Brinkmann, Alexander³ (AUTHOR), Bause, Hanswerner⁴ (AUTHOR), Bellgardt, Martin⁵ (AUTHOR), Bloos, Frank⁶ (AUTHOR), Dubb, Rolf⁷ (AUTHOR), Greim, Clemens⁸ (AUTHOR), Kaltwasser, Arnold⁷ (AUTHOR), Marx, Gernot⁹ (AUTHOR), Riessen, Reimer¹⁰ (AUTHOR), Spies, Claudia¹ (AUTHOR), Weimann, Jörg¹¹ (AUTHOR), Wöbker, Gabriele¹² (AUTHOR), Muhl, Elke¹³ (AUTHOR), Waydhas, Christian^14,15 (AUTHOR)

المصدر: GMS German Medical Science. 2017, Vol. 15, pDoc10-Doc10. 1p.

مصطلحات موضوعية: *CROSS infection prevention, *MECHANICAL ventilators, *ANALGESIA, *ARTIFICIAL respiration, *CLINICAL medicine, *CRITICAL care medicine, *ENTERAL feeding, *FORECASTING, *INDUCED hypothermia, *CONSCIOUS sedation, *KEY performance indicators (Management), *EARLY ambulation (Rehabilitation), *STANDARDS

مصطلحات جغرافية: GERMANY

مستخلص: Quality improvement in medicine is depending on measurement of relevant quality indicators. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI) from the year 2013 underwent a scheduled evaluation after three years. There were major changes in several indicators but also some indicators were changed only minimally. The focus on treatment processes like ward rounds, management of analgesia and sedation, mechanical ventilation and weaning, as well as the number of 10 indicators were not changed. Most topics remained except for early mobilization which was introduced instead of hypothermia following resuscitation. Infection prevention was added as an outcome indicator. These quality indicators are used in the peer review in intensive care, a method endorsed by the DIVI. A validity period of three years is planned for the quality indicators. [ABSTRACT FROM AUTHOR]