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The system development of quality management

for Clinical Practice Guidelines in Korea

Dong Ik Kim, Sung-Goo Chang, Heui Sug Jo,

Ein Soon Shin, Moo Kyung Oh

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Background 1

The policies of Clinical practice guidelines (CPGs) quality management were various among different countries.

Ref. : Legido-Quigley H, et al. Clinical guidelines in the European Union: Mapping the regulatory basis, development, quality control, implementation and evaluation across member states. Health Policy(2012)

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Background 2

In Korea, CPGs quality management is on the early stage – The subjects of development are various – Development competency are yet insufficient

Ref. : MW Jo et al., Assessment of the quality of clinical practice guidelines in Korea using the AGREE Instrument. J Korean Med Sci 2013; 28: 357-65.

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Current status of CPGs in Korea

Dimension Korean

Regulatory Basis -

Level of Development Professional (Academic society, Research group)

Main Body Korean Academy of Medical Sciences

Establishment of Quality Control

Korean AGREE II & Scoring Guide

Funding Central (Department of Health, KCDC)Unknown

Implementation tools -

Formal Evaluation -

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Continuous Efforts of KMAs

• Executive committee in KMAs• Establishment of informative system• Policy cooperation with KCDC

Constructing the Infrastructure

• Web-based AGREE II appraisal system• Consulting to the academies

Quality Improvement of CPGs

• Guideline for guidelines• Education program• Webzine

Development & Dissemination of CPGs

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Objectives

To share the experience of establishing the CPGs quality management system in Korea.

– To introduces the appraisal system of CPGs by the Korean Academy of Medical Sciences (KAMS).

– To introduces the characteristics of CPG quality management policy re-flecting the healthcare environment.

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About Korea

1960 1980 2005 2012

Population 24,989,241 37,406,815 47,041,434 50,948,272

Life expectancy 51.565.7

(M 61.8, F 70.0)

77.9(M 74.8, F

81.5)

78.6(M 75.1, F

81.9)

Infant mortality rate1)

89.7(1965) 33.2 5.3 2.9

GDP per capita ($) 155 1,674 22,797 31,900

No. of MDs2) 45 54 177 214

1) per 1,000 live births2) per 100,000 populations

8Ref. : OECD Health Statistics 2013.

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Synopsis of Korea Health Policy History

National Health Insurance with single insurer– Compulsory subscription by the law– Graded contribution according to economic power & Equal Insurance Benefits– All healthcare services, whether public or private, are mandatory NHI provider

1947 Founding of the Republic of Korea

1950~1953 Korean War

1963 Medical Insurance Act was enacted.

1979 Government and private school employees were covered.

1989 Coverage for whole population was accomplished.

2000 The separation of prescription and dispensing of drugs was implemented.

26yr

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CPGs in Korea 1

Dept. of Health Dept. of Health KCDC

Research group Research group Research group Academic societies Academic societies

CPG CPG CPG CPGCPG CPG

Dissemination

Quality Control

Implementation

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Characteristics No.(%)

Duration of development (mo) 1-6 7-12 13-24 Over 25 Unknown

12 (23.1)24 (46.2) 6 (11.5) 6 (11.5)4 (7.7)

Development methodsEvidence based methodsAdaptation of foreign guidelinesConsensus among specialistsMixedUnknown

8 (15.4)12 (23.1)10 (19.2)11 (21.2)11 (21.2)

Number of involved specialists12345Unknown

24 (46.2)12 (23.1) 6 (11.5) 6 (11.5)3 (5.8)1 (1.9)

Dissemination methods Sent out in printed forms Sent out in CD forms Sent out through the internetPosted in journalsPresentations at academic proceedingsClinical Practice Guidelines education

training

52 (100.0)- (-)- (-)

8 (15.4)22 (42.3)10 (19.2)

Ref. : HS Ahn et al., Development and Implementation of Clinical Practice Guidelines: Current Status in Korea. J Korean Med Sci 2012; 27: S55-60.

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CPGs in Korea 2

Quality variation among developer & CPGs– Detailed & rigorous evidence based approaches are scarce– Recommendations are made through a consensus of experts– Lack of interdisciplinary approaches & limited participation of method-

ologists with detailed techniques

Low Implementation – Lack of implementation tools & strategies– CPGs can’t reflect the healthcare environment d/t insufficient domestic

research

Absence of long-term plan of CPGs management– Fragmented Developer

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Continuous Efforts of KMAs

• Executive committee in KMAs• Establishment of informative system• Policy cooperation with KCDC

Constructing the Infrastructure

• Web-based AGREE II appraisal system• Consulting to the academies

Quality Improvement of CPGs

• Guideline for guidelines• Education program• Webzine

Development & Dissemination of CPGs

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Strengths of KMAs

Representation of the expert group– Participation of multidisciplinary experts– Support from key users

Consists of executive committee – Organizational support for the designing & performing the CPGs strate-

gies– Legal basis for quality control of CPGs

Restoration of mutual trust between the physicians & gov-ernment– Health policy as an implementation strategies– Financial support from government

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Appraisal system 1

Legal & Institutional support– Enacted the quality management regulation – Established the CPGs committee

Appraisal

Coordination & direction of whole process

Final decision

Technical & administrational support

Research agency for CPGs

Executive committee

Representatives of Academies

External Experts

President

CPGs committee

Executive committee

Evaluation Commit-tee

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Appoint 4 Appraisers

Appraisals& Report the result

Consideration of Result

Final decision

Request GPG producer

ExecutiveCommittee

Evaluation Committee

CPGs Committee

CPGs Committee

Application submission through informative system Pay for appraisal fee

Discuss the appraiser’s qualification & appoint 4 appraisers - 1st round : 3 specialist, 1 methodologist - 2nd round : 1 appraiser in 1st round

Web-based appraisal Korean AGREE II & Scoring guide

Contents of appraisal report - 23 items scores & Standardized domain scores - General critique of chief appraiser(2nd round appraiser)

Review the report Final decision of appraisal (Guarantee of KMA)

Notifying to Producer

Key responsible partyProcess step

Official appraisers

Major activity

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Appraisal system 2

Appraisers training– Educational course to be a official appraiser

• 5hrs for two rounds education program• Lecture & practice about Korea-AGREE II

– 49 professionals from 15 academic societies were trained

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Appraisal system 3

Assessment tools– Translated Korean-AGREE II & Scoring Guide– Web-based AGREE II evaluation system

Submission

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Mailing to appraisers Check the request in KoMGI

Appraisers through KoMGI

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Results mailing to devel-oper

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Challenges of Korea in CPGs

Current Stage

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Messages from Korea’s experience

정부와 전문가 단체 간의 신뢰 회복과 공동의 정책 추진

근거중심의학 , 임상진료지침 전문가의 양성

임상진료지침의 질 관리를 위한 단계적 접근

IT 기술의 활용

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Disclosure of Interests

This study was carried by financial support of Korea Centers for Disease Control and Prevention (KCDC) in the Ministry of Public Health and So-cial Welfare (2013-).

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THANKS FOR YOUR ATTENTION!