Adherence to clinical practice guidelines \nfor using invasive coronary angiography in chronic coronary artery disease
Notice bibliographique
Résumé
Clinical practice guidelines (CPG) are proposed as a strategy to reduce practice variation and aim to support the application of evidence-based recommendations in clinical practice. Guideline adherence is understood as the application of CPG in the clinical practice. This cumulative dissertation evaluates the guideline adherence in routine care based on the example of the decision-making process for using invasive coronary angiography (CA) in patients with chronic coronary artery disease (CAD) in Germany. For this purpose, four dissertation projects (DP) are conducted. \n \nDP 1 identifies methods to assess the guideline adherence of health care providers in the care of chronic CA by a scoping review. In DP 2 a prospective observational study (ENLIGHT-KHK) generates evidence on the guideline adherence in patients undergoing a decision-making process for receiving a CA to confirm or exclude an obstructive SCAD. DP 3 conducts a cost-effectiveness analysis based on the ENLIGHT-KHK-trial. The analysis examines the degree of guideline adherence and the corresponding clinical and economic outcomes. Major adverse cardiac events and costs of the complete guideline-adherent use (according to the German National Disease Management Guideline) are compared with those of in the clinical practice observed real-world CA-use. DP 4 examines the degree of guideline adherence according to the German and the European CPG using ENLIGHT-KHK data in patients who were referred to elective CA. \n \nDP 1 identifies similarities and differences in the methods used for assessing guideline adherence. Main steps of assessing guideline adherence were detected, and retrospectively collected secondary data were mostly used as a data source. Differences were detected in the definition of guideline adherence, the evidence underlying the CPG-recommendations, the evaluation and results of guideline adherence. DP 3 shows that in clinical practice ca. 26% of CAs were performed according to the German CPG-recommendations. To improve guideline adherence, a reduction of the amount of CAs in patients with SCAD would be necessary. A guideline-adherent CA-use is less expensive and associated with a slightly lower MACE compared with the observed adherence to CPGs by CA-use in clinical practice for the German Statutory Health Insurance (SHI). In patients referred to CA (DP 4), guideline adherence is 25.4% according to German and 20.4% according to the European CPG. \n \nThe findings of this dissertation indicate that the adherence to CPG is suboptimal in the clinical practice of CA-use in patients susceptive of chronic CAD in Germany for both the German and the European CPG. From the health economic perspective, improving adherence to CPG by (i) reducing the amount of CAs and ii) strengthening the role of non-invasive image guided testing modalities would result in cost savings and slightly lower MACE for the German SHI. \n \nTo improve guideline adherence, implementation by intersectoral strategies consisting of various components might be promising. Especially, these could affect structural barriers and facilitators when translating evidence-based recommendations into clinical practice.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,077 | 0,232 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,005 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,007 | 0,004 |
| Science ouverte | 0,002 | 0,004 |
| Intégrité de la recherche | 0,004 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,020 | 0,005 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».