Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice
Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice
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DOI：
10.1186/1748-5908-7-67
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发表时间：
2012-07-23
影响因子：
7.2
通讯作者：
Brouwers, Melissa C.
中科院分区：
文献类型：
--
作者：
Gagliardi, Anna R.;Brouwers, Melissa C.
背景：指南是根据最佳可用研究证据为医疗保健提供信息的重要工具。准则的使用在一定程度上取决于准则的质量，其中包括执行方面的建议，并已显示出各有不同。其他人假设这是由于指南制定手册中的说明有限。这项研究的目的是检查手册说明的实施建议。方法：我们使用了基于已建立的指南可实施性框架的定向和总结性内容分析方法。另一个研究小组确定了6本手册，列举了可实施领域和要素。结果：手册内容相似，但在特定领域缺乏足够的细节。最常见的是适应，其中包括的信息将帮助指导用户预期和/或克服组织和系统级别的障碍。在不止一本手册中，信息也缺乏可沟通性、教育患者或促进他们参与共享决策的信息、适用性或临床参数，以帮助临床医生为个别患者量身定做建议。讨论：大多数指导指南制定的手册缺乏关于纳入实施建议的完整信息。这些发现可以被那些开发手册的人用来考虑在这些领域扩展其内容。指南开发人员在计划其指南的内容和实现时也可以使用它，以便将两者集成在一起。可能需要为准则的制定和执行制定新的办法。如果准则包括执行建议，则准则的使用可能会有所改善，但这必须通过正在进行的研究进行评估。
Background: Guidelines are important tools that inform healthcare delivery based on best available research evidence. Guideline use is in part based on quality of the guidelines, which includes advice for implementation and has been shown to vary. Others hypothesized this is due to limited instructions in guideline development manuals. The purpose of this study was to examine manual instructions for implementation advice.Methods: We used a directed and summative content analysis approach based on an established framework of guideline implementability. Six manuals identified by another research group were examined to enumerate implementability domains and elements.Results: Manuals were similar in content but lacked sufficient detail in particular domains. Most frequently this was Accomodation, which includes information that would help guideline users anticipate and/or overcome organizational and system level barriers. In more than one manual, information was also lacking for Communicability, information that would educate patients or facilitate their involvement in shared decision making, and Applicability, or clinical parameters to help clinicians tailor recommendations for individual patients.Discussion: Most manuals that direct guideline development lack complete information about incorporating implementation advice. These findings can be used by those who developed the manuals to consider expanding their content in these domains. It can also be used by guideline developers as they plan the content and implementation of their guidelines so that the two are integrated. New approaches for guideline development and implementation may need to be developed. Use of guidelines might be improved if they included implementation advice, but this must be evaluated through ongoing research.