Leitlinienbasierte bildgebende diagnostische Anforderungsprofile in der Onkologie. Eine systematische vergleichende Analyse von evidenzbasierten Leitlinien

Unappropriate medical services are a big problem of nowaday health care. Underuse, overuse und misuse cause a worsening of health services quality and a costs growth. Radiological services, that make app. 10% costs in health care, are up to 19% unappropriate. This is caused by a lack of information concerning the appropriateness of a choice of methods. Of grate importance for the support of the appropriate ordering of the imaging methods are the evidence-based guidelines. One big problem is that the imaging in the evidence-based medicine is treated like that of secondary importance. There are only few of evidence-based radiologic guidelines. The evidence-based knowledge concerning appropriateness of imaging is dispersed in a lot of guidelines and recommendation levels are varied. Another methodical problem is caused by varied and sometimes unclear classifications of evidence and recommendation. All that reduces the guidelines implementation potential substantially. This paper represents the first systematic comparative analysis of nationally und internationally acknowledged evidence-based guidelines. It is the basis for internal hospital standards for the imaging in the oncology. The paper offers an integrated and homogeneous classification that makes a comparative analysis of guidelines possible. This system contains levels which can be found in all other systems: two strengths of recommendation (either strong or weak recommendation) and three evidence levels (good, fair or poor evidence). A bidimensional solution has been used for the graphic representation. A strength of recommendation has been coded according to a traffic light principle. The second dimension – an evidense level – has been marked by means of shading. That have made the cumulative tables clearer and simple to analyse. The cumulative tables represent the basis for the internal recommendations. They contain the information extracted from the evidence-based guidelines with remarks and references to the initial evidence and recommendation levels. The internal hospital recommendations are the result of the guidelines analysis as well as the local taloring. These recommendations are also colour-coded (however, without shading) and have been implemented as tables (in one-screen mode) in the hospital Intranet. The acceptance and effectiveness should be evaluated. A further local tailoring in the frames of an informal consensus has been planned.