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Project title: Clinical Practice Guidelines

Project registration number: CZ.03.2.63/0.0/0.0/15_039/0008221

Main project investigator:
Czech Health Research Council (AZV ČR)
President: Professor Miroslav Ryska, MD, PhD

Partners:
Ministry of Health of the Czech Republic
Institute of Health Information and Statistics of the Czech Republic


What are clinical practice guidelines?

“Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” (Lohr & Field, 1992).

What problem does the project solve?

Clinical practice guidelines (CPGs) are a very important instrument for modern health policy. Correctly created CPGs can be presented as an obligatory methodological approach by which healthcare professionals proceed to solve a specific medical problem in the process of diagnosis and treatment and which guarantees the use of effective diagnostic and therapeutic resources at the current level, both from the point of view of medical and other health sciences, as well as the efficient use of public resources. CPGs demonstrably contributes to the improvement of the provided services and increases the efficiency and availability of provided health services to patients. It is a guidance for reducing differences in access to healthcare for patients from different groups (geographical, demographic, specific health care payers, etc.). Implementation and usage of the CPGs can also be seen as a guarantee of a uniform level and quality of provided health services. At the same time, CPGs also represents a standardised algorithmisation of diagnostic and therapeutic procedures, which will be used in pre-graduate and postgraduate education of medical professionals, especially within specialisation education.

Currently, there are no centrally coordinated activities in the Czech Republic that would allow a unified and comprehensive coordination of the CPGs development process nor the processes directing the provided health services according to evidence-based practice and formulated according to a national methodology. Simultaneously an infrastructure including experts (epidemiology, biostatistics, public health, health services in accordance with valid legislation) and data sources (health information system) is needed.

What are the causes of the problem?

In the Czech Republic, there are available diagnostic and therapeutic procedures, however, there are inconsistent and are published by specific medical associations in a very variable form. This resulted in unequal/incomparable accessibility and quality of health care in the Czech Republic, limited revision and control activities and absence of evaluation of quality and effectiveness indicators. Absence of CPGs may potentially negatively affect the quality and safety of patient care.

What is the purpose of the project?

The aim of the project is to build a standardised system to support the development and up-date of Clinical Practice Guidelines in the Czech Republic in order to increase the availability and efficiency of healthcare services.

  1. Establishment of the Managing Authorities – the Guarantee Commission, the Methodological and Appraisal Commission. This will be achieved through Key Activity 1 (KA1), the output will be a fully functional managing member for the CPGs process. The fourth month of the implementation of the project will be fully operational.
  2. Prepare a draft system for developing, approving, publishing and updating CPGs. This aim will be achieved within Key Activity 2 (KA2) in which the necessary methodological framework will be created for the whole process of CPGs development, update and also a way of assessing the impact of CPGs on the quality of health services and patient health (as a feedback for revision and updating of CPGs). Verification of established procedures will be done on five pilot projects (making specific CPGs for specific diseases and conditions).
  3. Create at least 40 CPGs proposals in areas with the most defined heterogeneity in the Czech health care within Key Activity 3 (KA3).
  4. Set the design of the education system of the persons involved in the CPGs development in individual points of the rigid process and to raise awareness about CPGs in the Czech professional healthcare public. Information and education activities will be implemented within Key Activity 4 (KA4).

Conditions of CPGs development

  • Development of a uniform methodological approach for the preparation and critical appraisal of the CPGs, including the draft of the necessary legislative measures.
  • Development a methodology for publishing CPGs proposals, including the CPGs portal.
  • Development a education and training approach, including e-learning.
  • Preparation of a report summarising the requirements and limits (barriers) for the establishment of the Centre of Clinical Practice Guidelines under the Ministry of Health of the Czech Republic (updating of existing CPGs, development of new CPGs)

Who will use the CPGs?

  • healthcare providers and healthcare units,
  • to set the priorities of the Ministry of Health of the Czech Republic – to improve the efficiency of health services,
  • as a basis for the “purchase” (evaluation and reimbursement) of health services and inspection activities of health insurance companies, the creation of objective criteria for the evaluation of quality and safety in the provision of health services and care and their analysis,
  • to pre-graduate and postgraduate education of healthcare professionals,
  • to facilitate patient information,
  • as a background for the development of rational procedures of pharmacotherapy,
  • as a background for supervising the proper provision of health services.

Criteria for selection of CPG topic – reasons for rapid development of CPGs

  • high volume of care and high risk of disease and its complications,
  • high costs in terms of unit costs (for example targeted and innovative treatment),
  • high morbidity, incidence or prevalence escalating costs in a particular segment of care,
  • the need for a multidisciplinary approach to patient care in the diagnostic and therapeutic process,
  • the necessity to support the continuity of care, the health status of the population of the Czech Republic evaluated on the basis of epidemiological data provided by NHIS, cost of diagnostics and treatment