¿Interesa a los oncólogos incorporarse con entusiasmo al mundo de las guías de práctica clínica? / Is a matter of interest to oncologist to join enthusiastically to the world of clinical practice guides?

No disponible

[Are the guidelines guiding us reliable? Evaluation of the Spanish clinical practice guidelines]. / Las guías que nos guían son fiables? Evaluación de las guías de práctica clínica españolas.

BACKGROUND AND OBJECTIVE: There is a large proliferation of clinical practice guidelines (CPG), there being doubts on inconsistencies between the recommendations made and internal incongruencies, that affect the role of the guidelines as instruments helping the clinicians. This study aims to analyze the quality of a group of Spanish CPG and to assess the feasibility of use and consistency of the AGREE Instrument in its Spanish version, designed to evaluate the CPG. METHOD: A total of 278 CPG produced in Spain between January 1990 and December 2002 were identified. The originals of 61 guidelines were recovered from their authors and passed to the AGREE Instrument independently by four raters. Quality of the guidelines feasibility and reproducibility of AGREE were analyzed. RESULTS: For all the attributes of AGREE except in the editorial independence, more than 60% of the guidelines evaluated obtained a poor quality score, there being no domain in which more than 10% of the guidelines was excellent. The worst grading areas are those of applicability, participation and rigour of development of the guidelines. Of the 61 guidelines evaluated, the reviewers graded 25 as "very poor quality", 26 as "non recommendable" and 6 and 4 as "recommendable" or "highly recommendable", respectively. Interrater consistency was high. CONCLUSIONS: The mean quality of the Spanish guidelines evaluated is very low. The AGREE Instrument in its Spanish version is consistent for the Spanish guidelines and easy to use.

¿Las guías que nos guían son fiables? Evaluación de las guías de práctica clínica españolas / Are the guidelines guiding us reliable? Evaluation of the Spanish clinical practice guidelines

Fundamento y objetivo. Hay gran proliferación de guías de práctica clínica (GPC), existiendo dudas sobre inconsistencias entre las recomendaciones que realizan e incongruencias internas que comprometen el papel de las guías como instrumentos de ayuda a los clínicos. El estudio pretende analizar la calidad de un conjunto de GPC españolas, así como valorar la factibilidad de uso y consistencia del Instrumento AGREE en su versión en español, diseñado para la evaluación de GPC. Método. Se identificaron 278 GPC producidas en España entre enero de 1990 y diciembre del 2002. Se recuperaron, mediante solicitud a sus autores, originales de 61 guías a las que se pasó el Instrumento AGREE de forma independiente por cuatro evaluadores. Se analizó la calidad de las guías, la factibilidad y reproducibilidad del AGREE. Resultados. Para todos los atributos del AGREE, excepto en la independencia editorial, más del 60% de las guías evaluadas obtienen una puntuación de mala calidad, no habiendo ningún dominio en el que más del 10% de las guías sea excelente. Las áreas de peor calificación son las de aplicabilidad, participación y rigor en el desarrollo de las guías. De las 61 guías evaluadas, los revisores a 25 las califican de «muy poco recomendables», a 26 de «no recomendables» y tan sólo a 6 y 4 guías como «recomendables» o «muy recomendables», respectivamente. La consistencia entre evaluadores fue alta. Conclusiones. La calidad media de las guías españolas evaluadas es muy baja. El Instrumento AGREE, en su versión en español es consistente para las guías españolas y de uso fácil

Background and objective. There is a large proliferation of clinical practice guidelines (CPG), there being doubts on inconsistencies between the recommendations made and internal incongruencies, that affect the role of the guidelines as instruments helping the clinicians. This study aims to analyze the quality of a group of Spanish CPG and to assess the feasibility of use and consistence of the AGREE Instrument in its Spanish version, designed to evaluate the CPG. Method. A total of 278 CPG produced in Spain between Jannuary 1990 and December 2002 were identified. The originals of 61 guidelines were recovered from their authors and passed to the AGREE Instrument independently by four raters. Quality of the quidelines feasibility and reproducibility of AGREE were analyzed. Results. For all the attributes of AGREE except in the editorial independence, more than 60% of the guidelines evaluated obtained a poor quality score, there being no domain in which more than 10% of the guidelines was excellent. The worst grading areas are those of applicability, participation and rigour of development of the guidelines. Of the 61 guidelines evaluated, the reviewers graded 25 as «very poor quality», 26 as «non recommendable» and 6 and 4 as «recommendable» or «highly recommendable», respectively. Interrater consistency was high. Conclusions. The mean quality of the Spanish guidelines evaluated is very low. The AGREE Instrument in its Spanish version is consistent for the Spanish guidelines and easy to use

La historia clínica en la evaluación de la calidad asistencial de la cardiopatía isquémica: ¿es una fuente de información válida? / The clinical record in the evaluation of care quality in ischemic heart disease: is it a valid information source?

Objetivo. Examinar la disponibilidad de información en las historias clínicas (HC) para evaluar la calidad de la asistencia a la cardiopatía isquémica. Material y métodos. Se evalúan 722 historias de pacientes ingresados por cardiopatía isquémica. A partir de una revisión bibliográfica y los criterios de un panel de expertos se seleccionaron los datos necesarios para evaluar la asistencia. Se consideró una HC suficiente cuando disponía de al menos el 80 por ciento de los datos considerados necesarios por el panel. Resultados. El 78,5 por ciento de las HC disponen de suficientes datos. Los ancianos, la presentación clínica como equivalente isquémico y uno de los hospitales estudiados presentaban las HC más deficientes. Conclusiones. La HC es válida para evaluar retrospectivamente la asistencia médica. Las diferencias entre hospitales son importantes y deben tenerse en consideración antes de realizarse estudios sobre calidad clínica (AU)

[Hospital discharge reports may be an inadequate source of information to evaluate care quality]. / Los informes de alta hospitalaria médica pueden ser una fuente insuficiente de información para evaluar la calidad de la asistencia.

OBJECTIVES: To examine whether there is adequate available information in hospital discharge records (HDR) to retrospectively evaluate the adequacy of medical care to patients suffering from ischemic heart disease (IHD) and to relate care quality to physicians' decisions. MATERIAL AND METHODS: Cross-sectional study in which a total of 690 HDRs of patients admitted to three university teaching hospitals in Seville, Spain, on account of ischemic heart disease. The fulfillment of 15 parameters representing an adaptation to the CMBD regulation to IHD. The criterion of adequate information was set at 80% of data. RESULTS: Only 2.8% of HDRs contains adequate information. According to the analysed data, relevant fulfillment variability was observed. There were significant differences in fulfillment depending upon hospital and type of patient, with more information among younger patients and comorbidity. CONCLUSIONS: HDRs contain inadequate information to evaluate medical care.

[Medical history in the assessment of quality of care in ischemic cardiopathy: is it a valid information source?]. / La historia clínica en la evaluación de la calidad asistencial de la cardiopatía isquémica: es una fuente de información válida?

OBJECTIVE: To examine the availability of information in the clinical records (CR) to evaluate care quality in ischemic heart disease. MATERIAL AND METHODS: A total of 722 clinical records of patients admitted because of ischemic heart disease were evaluated. Based upon a bibliographic review and the criteria of an expert panel necessary data to evaluate care quality were selected. A CR was considered adequate when at least 80% of data considered necessary by the expert panel were available. RESULTS: 78.5% of CR had adequate data. The elderly, clinical presentation as ischemic equivalent and one of the hospitals studied had most deficient CR. CONCLUSIONS: The CR is valid to retrospectively evaluate medical care. Differences between hospitals were important and should be taken into consideration before studies on clinical quality are performed.

[A reproducibility and validity study of a systematic review on ischemic cardiopathy. The Study Group of the Quality of Care (GRECA)]. / Estudio de la reproducibilidad y validez de una revisión sistemática sobre cardiopatía isquémica. Grupo de Estudio de la Calidad Asistencial (GRECA).

BACKGROUND: The systematic literature reviews have been proposed as a method of scientific evidence identification since they protect the final product from the subjectivity of each primary source reviewer. However, it is not known whether the different ways of evidence synthesis accomplish suitable criteria of objectivity, reliability and biases protection so as to be considered scientifically valid. An experiment of reliability and validity of a systematic literature review about coronary heart disease was carried out. MATERIAL AND METHODS: Study of blind concordance between two independent reviewers for the identification, selection, retrieval and quality evaluation of the articles by using the same protocol. The concordance was analysed by the kappa index for two observers in different categories. The validity was evaluated throughout the acceptability of the review users. RESULTS: The concordance for their identification capacity was poor although they used the same key words (869 versus 476). But the concordance improved when considering selection (26.6% versus 29.2%), retrieval (agreement = 76%) classification by kind of article (kappa = 0.60) and scoring by strength of the evidence (kappa = 0.87). The acceptability was high among review users. CONCLUSIONS: It would be assumed that, even under tight rules of performance, the systematic literature reviews are not completely protected against some biases which could damage their validity in a non easily controllable form. The implication of reviewers, experts in documentation and users of the literature, together with pilot studies performed previous to the review, seems to be the best way to yield better results.