UEG Guidelines framework to guide clinical practice

The United European Gastroenterology Journal (UEG) is committed to improving clinical gastrointestinal care in Europe and has invested in bringing knowledge to its community of gastrointestinal physicians. Typically, this has been done using the UEG education channel which offers a vast collection of talks, interviews, abstracts and cartoons which are most often related to the yearly UEG week. While this is an excellent resource, UEG has taken the step beyond mere offering of resources in an effort to get digestive care to the next level. One fine example is the joint venture with the European Society of Gastrointestinal Endoscopy (ESGE) and targeted daily endoscopic care. This project established performance measures for endoscopy services that serve as a target for the improvement of delivery of endoscopic care. Performance measures can be used to measure the quality of organisational structure, healthcare processes, or clinical outcomes. These efforts have resulted in a series of important documents that summarise the development and construction of performance measures that allow gastrointestinal physicians to identify and address specific deficits in their service. For example, this quality improvement initiative defined seven key performance measures for endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) such as adequate antibiotic prophylaxis before ERCP as well as targets for bile duct cannulation and bile duct stone extraction. The UEG has published a number of articles describing the performance measures for endoscopy services, colonoscopy and small-bowel endoscopy. This is extremely helpful as it allows the assessment of individual endoscopists, benefits endoscopy training and facilitates comparison between units. We encourage the readers of the UEG to start efforts to implement these performance measures in their own unit. Another branch of the tree of evidence-based medicine is the development of clinical guidelines. These are highly desired as they aptly summarise the current body of evidence and provide recommendations for diagnosis and management of diseases and offer guidance in ambiguous clinical situations. The process that leads to a clinical guideline is divergent. Most processes consist of a formal literature search and review to search for the most relevant evidence available and use a Delphi process among experts. This is a group facilitation technique that includes an iterative multistage process to transform opinion into group consensus. The European Association for the Study of the Liver (EASL), for example, has a streamlined process in place. This is a lean systematic process that starts with a small team of experts who are tasked with the development of clinical practice guidelines and benefit from the input of independent external reviewers as well as from the EASL governing board. This has proved to be a very successful strategy and has resulted in the publication of more than 30 EASL guidelines on various aspects of liver diseases. Performance measurements have a broader use and, for example, help to improve reporting standards in guideline development. The use of performance measures stimulates the use of correct methodologies and potentially improves standards of guideline reporting. In this issue of the UEG, the UEG quality of care taskforce publishes a framework for quality guidelines in order to assist UEG member societies in the process of developing guidelines. This framework offers a step-tostep template for guideline design that starts with an idea (question) to the final product (published guideline). As such, this is a highly welcome development. It will lead to the creation of more uniform UEG supported guidelines and should improve both the quality and consistency of guidelines. A logical next step that needs to be taken is the inclusion of patient-reported outcome measures, including quality of life measures. Currently, these items are invariably missing in clinical practice guidelines but are highly relevant for the life of our patients. The inclusion of patients as part of the panel of clinical experts should be encouraged as this ensures that the patients’ concerns are being taken into account.