Development of National Set of Clinical Standards and Healthcare Indicators and First Results in the Field of Neurology

Authors: M. Suchý 1;  J. Bednařík 2;  O. Škoda 2;  S. Voháňka 2;  E. Ehler 2;  M. Pátá 1;  P. Kožený 1;  P. Klika 3;  L. Dušek 3
Authors‘ workplace: Národní referenční centrum 1;  Česká neurologická společnost ČLS JEP 2;  Institut biostatistiky a analýz Masarykovy univerzity, Brno 3
Published in: Cesk Slov Neurol N 2010; 73/106(5): 569-577
Category: Standard Treatment


The first part of the article focuses on description of the methodology of the clinical practice guidelines and clinical standards development as used by the National Reference Centre of the Czech Republic (NRC) in cooperation with medical associations. The methodologies are based on foreign resources. The clinical practice standards are developed on the basis of evidence based medicine, mainly in the form of adaptation of similar documents processed in international systems. They are adjusted to our conditions, complemented with clinical criteria, indicators, economic parameters and also informative articles for patients. These complexly processed documents are in the NRC terminology called the “clinical standards”. The second part of the document describes first experience with development of the clinical standards in cooperation with the Czech Neurological Association, especially the Clinical standard for treatment of patients with autoimmune neuromuscular disorders by using intravenous human immunoglobulin and plasma exchange and the Clinical standard for diagnostics and treatment of ischemic stroke. The most interesting outcomes are different pieces of experience with consensus achievability and with success rate of statistic calculation, quality indicators and economic parameters.

Key words:
clinical practice guideline – evidence based medicine – quality – effectiveness – indicators – implementation


1. Guideline International Network (G-I-N). [online]. Dostupné z URL:

2. Schünemann HJ, Oxman AD, Brozek J, Glasziou P, Bossuyt P, Chang S et al. GRADE: assessing the quality of evidence for diagnostic recommendations. Evid Based Med 2008; 13(6): 162–163.

3. Atkins D, Briss P, Eccles M, Flottorp S, Guyatt G, Harbour R et al. Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system. BMC Health Serv Res 2005; 5(1): 25.

4. Claridge JA, Fabian TC. History and development of evidence-based medicine. J Word Surg 2005; 29(5): 547–553.

5. Guyatt GH, Oxman AD, Vist G, Kunz R, Falck-Ytter Y, Alonso-Coello P et al. GRADE: an emerging concensus on rating quality of evidence and strength of recommendations GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336(7650): 924–926.

6. Coopey M, Nix M, Clancy C. Evidence-based practice: AHRQ’s role in generating and disseminating knowledge. AORN J 2007; 86(5): 857–860.

7. Agency for Healthcare Research and Quality (AHRQ). [online]. Dostupné z URL:

8. European Stroke Organization (ESO). [online]. Dostupné z URL:

9. The AGREE Collaboration. The Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument. [online]. Dostupné z URL:

10. Canadian Medical Association. Guidelines for Canadian clinical practice guidelines. [online]. Dostupné z URL:

11. National Institute for Health and Clinical Excellence. [online]. Dostupné z URL:

12. Scottish Intercollegiate Guidelines Network. [online]. Dostupné na

13. Clinical Practice Guideline: 2008 Update. Public Health Service 2008.

14. Clancy C, Slutsky J, Chest. Guidelines for guidelines: we’ve come a long way. Chest 2007; 132(3): 746–747.

15. Conway P, Clancy C. Comparative effectiveness research-implications of the Federal Coordinating Council’s report. N Engl J Med 2009; 361(4): 328–330.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 5

2010 Issue 5

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account