Towards evidence-based clinical practice:: an international survey of 18 clinical guideline programs
Towards evidence-based clinical practice:: an international survey of 18 clinical guideline programs
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DOI：
10.1093/intqhc/15.1.31
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发表时间：
2003-02-01
影响因子：
2.6
通讯作者：
Zaat, J
中科院分区：
文献类型：
--
作者：
Burgers, JS;Grol, R;Zaat, J
目标。系统地描述指导程序的结构和工作方法。描述性调查使用问卷与32个项目的基础上，从文献派生的框架。答案被制成表格并由参与者检查。研究参与者。美国、加拿大、澳大利亚、新西兰和9个欧洲国家的18个重要指南组织的关键线人。主要结果测量。历史、目标、方法、产品和交付、实施、评估、更新指导方针的程序和未来计划。结果。大多数指导方案的建立是为了提高卫生保健的质量和有效性。大多数使用电子数据库收集证据和系统审查来分析证据。在缺乏证据的情况下使用共识程序。所有指南在出版前都经过审查。授权通常用于支持指导方针。所有指引均备有应用工具，并广泛利用互联网进行传播。实现策略在不同的组织中有所不同，较大的组织将其留给本地组织。几乎所有学校的课程都有质量保证体系。一半的项目没有正式的更新程序。循证医学原则主导了当前的指导方案。最近的项目受益于长期项目创造的方法。在强调传播和实施方面存在差异，这可能是由于卫生保健系统以及政治和文化因素的差异。应鼓励国际合作，以改进指南方法，并使指南制定所需证据的收集和分析全球化。
Objective. To describe systematically the structures and working methods of guideline programs.Design. Descriptive survey using a questionnaire with 32 items based on a framework derived from the literature. Answers were tabulated and checked by participants.Study participants. Key informants of 18 prominent guideline organizations in the United States, Canada, Australia, New Zealand, and nine European countries.Main outcome measures. History, aims, methodology, products and deliveries, implementation, evaluation, procedure for updating guidelines, and future plans.Results. Most guideline programs were established to improve the quality and effectiveness of health care. Most use electronic databases to collect evidence and systematic reviews to analyze the evidence. Consensus procedures are used when evidence is lacking. All guidelines are reviewed before publication. Authorization is commonly used to endorse guidelines. All guidelines are furnished with tools for application and the Internet is widely used for dissemination. Implementation strategies vary among different organizations, with larger organizations leaving this to local organizations. Almost all have a quality assurance system for their programs. Half of the programs do not have formal update procedures.Conclusions. Principles of evidence-based medicine dominate current guideline programs. Recent programs are benefiting from the methodology created by long-standing programs. Differences are found in the emphasis on dissemination and implementation, probably due to differences in health care systems and political and cultural factors. International collaboration should be encouraged to improve guideline methodology and to globalize the collection and analysis of evidence needed for guideline development.