Table 4 QIs on related topics in international and German S3-CPGs with corresponding recommendations (examples)

 SIGN melanoma 2017

#_int3 (P); rr: 95%

Multi-Disciplinary Team Meeting (MDT)

Numerator:

Number of patients with cutaneous melanoma discussed at the MDT before definitive treatment (wide local excision, chemotherapy/SACT, supportive care and radiotherapy).

Denominator:

All patients with cutaneous melanoma.

(Exclusions: Patients who died before first treatment)

All patients with a diagnosis of melanoma should be discussed at a specialist multidisciplinary team (MDT) meeting (GPP).

(implicit connection)

032/024OL 2016

#_S310 (P); rr: N.R.

Presentation melanoma team meeting

Numerator:

Patients with stage IV melanoma, who are presented in an interdisciplinary team meeting

Denominator:

Patients with stage IV melanoma

3.146

Patients with metastatic melanoma (as of stage III) should be presented in an in an interdisciplinary team meeting to discuss further diagnostic and therapy. […] (strong rec., consensus-based)

(explicit connection)

 SIGN ovar 2013

#_int9 (P); rr: 90%

First-line Chemotherapy

Numerator:

Number of epithelial ovarian cancer patients who receive chemotherapy treatment involving either paclitaxel in combination with a platinum-based compound or carboplatin only

Denominator:

All epithelial ovarian cancer patients

(Exclusions:

• Patients with low-grade serous disease.

• Patients with FIGO stage 1a or 1b, low grade (G1) disease.

• Patients with Stage 1a clear cell tumours.

• Patients who decline chemotherapy treatment.)

#_int9:

First line chemotherapy treatment of epithelial ovarian cancer should include a platinum agent either in combination or as a single agent, unless specifically contraindicated (GoR: A, LoE: 1⁺⁺).

Carboplatin is the platinum drug of choice in both single and combination therapy (GoR: A, LoE: 1⁺⁺).

(implicit connection)

032/035OL 2013

#_S310 (P); rr: N.R.

Combination therapy for platinum sensitive relapse

Numerator:

Number of patients with a platinum-based combination therapy

Denominator:

All patients with platinum-sensitive relapse of an ovarian carcinoma and chemotherapy, outside of clinical studies

9.5

Patients with platinum-sensitive relapse of an ovarian carcinoma should receive with a platinum-based combination therapy if there is the indication for chemotherapy (strong rec., consensus-based). […] (explicit connection)

 KCE gastrointest 2012

#_int1 (P); rr: N.R.

Staging

Numerator:

All patients diagnosed with oesophageal cancer in a given year discussed at the multidisciplinary team (MDT) meeting within 1 month after incidence date.

Denominator:

All patients diagnosed with oesophageal cancer in a given year.

All patients diagnosed with oesophageal cancer should be discussed at a multidisciplinary meeting (GoR: strong, LoE: low). (explicit connection)

021/023OL 2014

#_S34 (P); rr: N.R.

Therapy recommendation from multidisciplinary tumour conference

Numerator:

Number of patients with therapy recommendation from multidisciplinary tumour conference before therapy (staging completed)

Denominator:

All patients with oesophageal cancer

Therapy recommendations should be made in a multidisciplinary tumour conference. […] (strong rec., consensus-based). (explicit connection)

 NICE diabtypeI 2015 and NICE diabtypeII 2016

#_int1 (P); rr: N.R.

NM27

The percentage of patients newly diagnosed with diabetes, on the register, in the preceding 1 April to 31 March who have a record of being referred to a structured education programme within 9 months after entry on to the diabetes register.

NICE diabtypeI 2015: rec 1.3.1

Offer all adults with type 1 diabetes a structured education programme of proven benefit, for example the DAFNE (dose-adjustment for normal eating) programme. Offer this programme 6–12 months after diagnosis (strong rec).

NICE diabtypeII 2016: rec 1.2.1

Offer structured education to adults with type 2 diabetes and/or their family members or carers (as appropriate) at and around the time of diagnosis, with Type 2 diabetes in adults: management annual reinforcement and review. Explain to people and their carers that structured education is an integral part of diabetes care (strong rec).

(explicit connections)

NICE diabtypeII 2016: rec 1.2.2

[…]

nvl/001f 2012

#_S31 (P); rr: N.R.

Numerator:

Number of patients, for which the offer of a structured education program is documented directly after the diagnosis is being made

Denominator:

All people with newly diagnosed diabetes mellitus

2-1

Each human with diabetes mellitus and if necessary important reference persons (e.g. relatives) should be offered a structured education program as an indispensable component of the diabetes management directly after the diagnosis is made and regularly in the course of the disease (GoR ⇑⇑). (explicit connection)

 ICSI backpain 2012

#_int3 (P); rr: N.R.

Numerator:

Number of patients for whom the clinician ordered imaging studies during the six weeks after pain onset, in the absence of "red flags."

Denominator:

Number of patients with non-specific back pain diagnosis.

Annotation #11

• […]

• Clinicians should not recommend imaging (including computed tomography (CT), magnetic resonance imaging (MRI) and x-ray) for patients with non-specific low back pain (strong rec, moderate quality evidence).

[…] (explicit connection)

nvl/007 2011

#_S32 (P); rr: N.R.

Imaging techniques for acute back pain

Numerator:

Number of patients for which imaging diagnostics is conducted without reason

Denominator:

All patients with acute back pain and without “red flags” after anamnesis and clinical examination.

3-5

Imaging diagnostics is not recommended in case of acute back pain after exclusion of dangerous conditions by anamnesis and clinical examination (GoR ⇓⇓). (explicit connection)

 NICE bipolar 2016

#_int2 (P); rr: N.R.

NM16

The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of BMI in the preceding 15 months

Rec 1.2.12

Ensure that the physical health check for people with bipolar disorder,

performed at least annually, includes:

• weight or BMI, diet, nutritional status and level of physical activity

• […] (explicit connection)

038/019 2012

#_S318 (P); rr: N.R.

General principle

Numerator:

Percentage of patients, for whom weight data are documented repeatedly.

Denominator:

All patients

Therapy-general principle 4

Regular weight controls should be conducted because of possible weight gain, especially during therapy with mirtazapine, tricyclic antidepressants, lithium, valproic acid, clozapine, olanzapine, quetiapine, risperidone, and zotepine.

(moderate rec., consensus-based)

(explicit connection)

 ICSI diabtypeII 2014

#_int1 (P); rr: N.R.

Numerator:

Number of patients who are advised about lifestyle modification and nutrition therapy within one year of diagnosis.

Denominator:

Number of patients ages 18–75 years old who have T2DM.

Nutrition therapy

A qualified health professional (which may include a clinician, dietitian, nursing staff and pharmacist) should provide nutrition therapy to a patient diagnosed with T2DM as part of a global treatment plan (GoR: strong, quality of evidence: moderate). (explicit connection)

nvl/001f 2012

#_S31 (P); rr: N.R.

Numerator:

Number of patients, for which the offer of a structured education program is documented directly after the diagnosis is being made

Denominator:

All people with newly diagnosed diabetes mellitus

2-1

Each human with diabetes mellitus and if necessary important reference persons (e.g. relatives) should be offered a structured education program as an indispensable component of the diabetes management directly after the diagnosis is made and regularly in the course of the disease (GoR ⇑⇑). (explicit connection)

 SIGN VTEPrev 2014

#_int1 (P); rr: N.R.

Compliance with and recording of risk assessment in all patients admitted to or presenting acutely at hospital.

All patients admitted to hospital or presenting acutely to hospital should be individually assessed for risk of VTE and bleeding. The risks and benefits of prophylaxis should be discussed with the patient (GoR: D).

(implicit connection)

003/001 2015

_S32 (P); rr: ≥ 95 %

Proportion of patients with documented information about benefits, risks and alternatives of prophylactic interventions in relation to all patients receiving VTE prophylaxis.

3.8

The conducted risk assessment of a VTE and the resulting interventions of a VTE prophylaxis have to be discussed with the patient regarding benefits, risks and alternatives (according to legal requirements) (GoR ⇑⇑) (explicit connection)

 ICSI pain 2016

_int4 (P); rr: N.R.

Numerator:

Number of patients with new opioid prescriptions that are <= 20 pills or 3 days’ supply of short-acting opioid.

Denominator:

Number of patients with chronic pain diagnosis with a new opioid prescription (no opioid prescription for at least 90 days). Exclude patients with an opioid prescription for cancer, migraine and end-of-life care.

Acute or acute on chronic pain

• The first opioid prescription for acute pain should be no more than 20 low-dose, short-acting opioids or three days of medication, whichever is less. The total dose for acute pain should not exceed 100 MME.

• For patients presenting in acute pain, already on chronic opioids, opioid tolerant or on methadone, use the same pill and dose limits as for opioid-naïve patients (strength of rec. N.R.). (explicit connection)

145/003 2014

# _S31 (P); rr: N.R.

Number of patients with somatoform pain disorders, which receive opioid analgesics.

Pain associated with functional/somatoform disorders should not be treated with opioid analgesics (consensus-based). (explicit connection)