'Best practice'

European Commission Directorate-General For Employment Social Affairs And Inclusion

Description

State of the art and perspectives in the EU for improving the effectiveness and efficiency of European health systems
Social policy

Sujets

• Health care
• Health care system
• Member state of the European Union
• Sociologie, société et politique

Informations

• Publié par: EUROPEAN-COMMISSION-DIRECTORATE-GENERAL-FOR-EMPLOYMENT_SOCIAL-AFFAIRS-AND-INCLUS
• Nombre de lectures: 31
• Langue: English
• Poids de l'ouvrage: 3 Mo

Extrait

'Best practice': State of the art and perspectives
in the EU for improving the effectiveness
and efficiency of European health systems
Employment & social affairs
European Commission 'Best practice': State of the art and
perspectives in the EU for improving the
effectiveness and efficiency of European
health systems
Employment & social affairs
Health
European Commission
Directorate-General for Employment, Industrial Relations
and Social Affairs
Directorate V/F.1
Manuscript completed in March 1999 This report was financed by and prepared for the use of the European Commission, Directorate-
General for Employment, Industrial Relations and Social Affairs. It does not necessarily represent the
Commission's official position.
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Cataloguing data can be found at the end of this publication.
Luxembourg: Office for Official Publications of the European Communities, 1999
ISBN 92-828-7934-8
© European Communities, 1999
Reproduction is authorised provided the source is acknowledged.
Printed in Belgium
PRINTED ON WHITE CHLORINE-FREE PAPER PREFACE
The identification and the exchange ofinformation related to 'best practice' in different areas
of health systems is one important area where a consensus has evolved during the debate on
the Community's future public health policy. The Commission's April 1998 communication
on the development of public health policy in the European Community1 points both to the
importance of the topic and its diversity.
The relevant paragraph in the Communication reads as follows:
'48. A major emphasis within the information strand covering both health status and health
systems would be placed on best practice in health care, i.e. the current best evidence as
regards the safety, efficacy, effectiveness and cost-effectiveness of different approaches to
health promotion, prevention, diagnosis and treatment; for instance the cost-effectiveness of
screening programmes, health education programmes, emergency services and new
pharmaceutical products. The work would aim to promote and bring together activities in the
Member States in the fields of evidence-based medicine, quality assurance and improvement,
appropriateness of interventions, and health technology assessment. Co-ordination of work in
these fields would be supported and set on a formal footing in order to pool the expertise of
the centres in the Member States, to gather and exchange information, stimulate international
studies, and improve the dissemination of findings. '
In order to clarify issues and help identify priority areas in this field for the Community's
forthcoming public health programme, the Commission has financed a number of projects in
the general context described above.
This document presents the work undertaken by a team led by the Medizinische Hochschule
Hannover (Germany) which takes stock of the state of the art and the discussions in the
research community around different concepts of 'best practice', including a review of the
different techniques and methodologies which have been developed. It is intended as a
resource document for developing public health policy both at national and at Community
level.
The Commission wishes to thank all researchers and collaborators involved, in particular Dr
Elke Jakubowski, Dr Matthias Perleth and Dr Reinhard Busse, for carrying out their work so
successfullv.
1 COM (98) 230 final of 15.4.1998 TABLE OF CONTENTS
EXECUTIVE SUMMARY 9
1 INTRODUCTION 13
1.1 Background to the project with regard to European Union public health policy 1
1.2 Policy perspective of the project4
1.3 Research perspective of the project5
1.4 Aims and objectives of the project6
1.5 Structure of the report 17
2 MATERIAL AND METHODS8
3 DEFINITIONS OF BEST PRACTICE 21
3.1 Best Practice definitions for health care
3.2 Best Practice definitions in health policy programmes3
4 CLASSIFICATION FRAMEWORK FOR DEFINING BEST PRACTICE 27
4.1 Best Practice framework: the case for Evidence-Based Health Care (EBHC) 3
4.2 Best Practice activities 37
4.2.1 Health Technology Assessment (HTA)
4.2.2 Clinical Practice Guidelines (CPGs) 41
4.2.3 Evidence-Based Medicine (EBM)6
4.3 Related disciplines 52
4.3.1 Clinical Epidemiology (CE)
4.3.2 Health Economics (HE)
4.4 Related methods8
4.4.1 Systematic Reviews
4.4.2 Appropriateness and Necessity Research based on consensus methods 59
4.4.3 Outcomes Research 6
4.4.4 Effectiveness Research4
4.4.5 Decision Analysis (DA)6
4.4.6 Satisfaction Research7
5 4.5 Transferability of results 68
4.6 Dissemination of information on Best Practices 73
4.6.1 Meaning of dissemination
4.6.2 Practice ofn
4.6.3 Current issues for improving dissemination4
4.7 Implementation of information on Best Practices5
4.7.1 Meaning of implementation and implementation barriers 7
4.7.2n tools 76
4.7.3 Consumer information methods9
4.7.4 Current issues for improving implementation 83
4.8 Monitoring the impact of Best Practice4
4.9 Conclusion 87
5 STATE OF BEST PRACTICE IN THE EU MEMBER STATES 88
5.1 EBM institutions
5.1.1 Cochrane Centres8
5.1.2 Other EBM institutions 90
5.1.3 Non-institutionalised EBM information resources in Europe 91
5.2 HTA activities
5.3 Guidelines development activities4
6 BEST PRACTICE MODEL CONCEPT FOR CAROTID ARTERY
STENOSIS 97
7 RECOMMENDATIONS FOR EUROPEAN CO-ORDINATION 101
7.1 Recommendations for research into best practice activities, related disciplines, methods
and tools 10
7.2 Development of public-health policy activities aimed at improving decision-making along
the lines of best practice in health care3
7.2.1 Improving the availability and use of evidence (including systematic reviews) 10
7.2.2 Promoting existing activities for best practice 10
7.2.3g information systems for European public health4
7.3 The next step 106
8 REFERENCES7 APPENDIX 118
A.l Persons involved in the project
Α. 1.1 ProjectPartners
Α. 1.2 Reviewers of the project report : 119
Α.1.3 Experts who have provided comments on specific topics 120
A.2 Workshop 121
A.2.1 List of Participants
A.2.2 Original workshop programme2
A.3 Additional Material3
A.3.1 European Community mandates for health
A.3.1.1 Maastricht Treaty (in summary)
A3.1.2 Treaty of Amsterdam (in summary) 12
A.3.2 Example of a 'best clinical practice' approach4
A.3.3 Electronic communication from Gerry Van Wyk5
A.4 Levels of Evidence scale of the U.S. Preventive Services Task Force 126 LIST OF FIGURES AND TABLES
List of Figures
Figure 1 : Relationship between the public health perspective and the clinical perspective.... 15
Figure 2: The new model for setting and monitoring quality standards in the NHS 25
Figure 4: Input domain for Best Practice 30
Figure 5: Implementation domain for Best Practice1
Figure 6: Outcome domain for the Best Practice framework2
Figure 7: The concept of Evidence-Based Health Care4
Figure 8: Consecutive components of the patient chart 49
Figure 9: Evidence-Based Health-care activities within the three compartments 10
List of Tables
Table 1: Overview of the main sources ofinformation in the first phase of the project 19
Table 2: Application areas and users of HTA 38
Table 3: Summary overview of activities 51
Table 4: Differences between narrative and systematic reviews
Table 5: Factors explaining differences in 'Efficacy' and 'Effectiveness' 69
Table 6: Cochrane Centres in the European Union 8
Table 7: Initiatives by Type of Assessment in Germany 93
Table 8: Research Recommendations 102