Developing and implementing clinical practice guidelines.
Developing and implementing clinical practice guidelines.
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DOI：
10.1136/qshc.4.1.55
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发表时间：
1995-03-01
期刊：
影响因子：
--
通讯作者：
Sheldon, T
中科院分区：
文献类型：
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作者：
Grimshaw, J;Freemantle, N;Sheldon, T
有效医疗保健公报的重点是对临床和成本效益的研究证据进行系统审查，以帮助为 NHS 的决策者和临床医生提供信息。然而，提供信息本身很少足以刺激实践中的相应变化。可以采用各种实施策略来促进研究证据的使用。受到越来越多关注和支持的一种方法是制定和实施临床实践指南。2这些是“系统制定的声明，旨在帮助医生和患者就特定临床情况做出适当的医疗保健决策”。 3 之前的一些公告主张将有效性证据纳入指南，4 5 有人认为医疗保健专员应该购买指南或方案而不是简单的程序。 6 本文探讨了实践指南是否可以改变卫生专业人员的行为以及如何最好地将其引入临床实践的证据。还考虑了高质量指南的特点以及购买者如何在调试中使用指南。评估指南的实施情况 Grimshaw 和 Russell 对 1976 年至 1992 年之间发表的临床指南进行了严格的评估。7 在本文中，该审查已更新，包括另外 32 项先前未确定的或截至 1994 年 6 月发表的研究。为了确定临床指南的评估，DHSS-DATA，5 Embase，9 Medline，'0 和检索了自 1975 年以来的所有“SIGLE”数据库；检索了相关主题 12-26 的出版参考书目；并审查了文章中的引文。同事提供了进一步的参考文献。对临床指南的调查进行了深入审查，如果它们主要针对医务人员，如果它们使用严格的研究设计来评估指南在患者护理过程或结果方面的有效性，以及它们是否报告了足够的数据进行统计分析。
The Effective Health Care bulletins have con-centrated on providing systematic reviews of the research evidence on clinical and cost effectiveness to help inform decision makers and clinicians in the NHS. However, providing information by itself is rarely sufficient to stimulate corresponding change in practice. Various implementation strategies can be used to promote the use of research evidence. One approach which has received growing attention and support is the development and implemen-tation of clinical practice guidelines.'2 These are" systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances." 3 Some previous bulletins argued for the incorporation of the evidence on effectiveness into guidelines, 4 5andit has been argued that healthcare commissioners should purchase guidelines or protocols rather than simple procedures. 6 This paper examines the evidence on whether practice guidelines can change the behaviour of health professionals and how best to introduce them into clinical practice. The characteristics of high quality guidelines and how purchasers might use guidelines in commissioning are also considered.Evaluating implementation of guidelines Grimshaw and Russell undertook a systematic review of rigorous evaluations of clinical guidelines published between1976 and 1992.7 In this paper the review has been updated to include another 32 studies either previously unidentified or published up until June 1994. To identify evaluations of clinical guidelines the DHSS-DATA, 5 Embase, 9 Medline,'0 and SIGLE" databases were searched, all since 1975; published bibliographies of related topics12-26 were searched; and citations in articles were reviewed. Further references were provided by colleagues. Investigations of clinical guidelines were reviewed in depth if they were intended primarily for medical staff, if they used rigorousstudy designs to evaluate the effectiveness of guidelines in terms of the process of care or outcome for patients, and if they reported sufficient data for statistical analysis.