Evidence and Value: Impact on DEcisionMaking--the EVIDEM framework and potential applications.
Evidence and Value: Impact on DEcisionMaking--the EVIDEM framework and potential applications.
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DOI：
10.1186/1472-6963-8-270
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发表时间：
2008-12-22
影响因子：
2.8
通讯作者：
Rindress D
中科院分区：
文献类型：
--
作者：
Goetghebeur MM;Wagner M;Khoury H;Levitt RJ;Erickson LJ;Rindress D
医疗决策是一个复杂的过程，依赖于不同类型的证据和价值判断。我们这项研究的目标是制定一个实用的框架，以促进决策方面的支持审议过程，提供证据，并加强决策的沟通。广泛的分析文献和记录决策过程在地球仪进行，以探讨目前使用的步骤，使决策方面的背景下（从证据生成的沟通决定）和思维过程（决策的概念组成部分）。确定了支持决策的需要和现有方法，以便为EVIDEM框架奠定基础。开发了一个由七个模块组成的框架，这些模块可以在医疗保健干预的生命周期中发展。可以量化的决策组成部分，即，医疗保健干预的内在价值和可用证据的质量被组织成矩阵。一个多标准决策分析（MCDA）价值矩阵（VM）的开发，包括15个可量化的组件，目前在决策中考虑。制定了一种方法来综合VM每个组成部分所需的证据，包括电子访问全文源文件。设计了一个质量矩阵来量化决策者通常需要的12种证据的三个质量标准。开发了一个综合系统，以优化专家的数据分析、综合和验证，与协作结构兼容。EVIDEM框架通过系统评估和传播决策所依据的证据和价值，促进透明和有效的医疗保健决策。它提供了一个协作框架，可以连接所有利益相关者，并通过允许共享数据，资源和价值来服务于地方，国家和国际层面的医疗保健社区。需要验证和进一步发展，以探索这一方法的全部潜力。
Healthcare decisionmaking is a complex process relying on disparate types of evidence and value judgments. Our objectives for this study were to develop a practical framework to facilitate decisionmaking in terms of supporting the deliberative process, providing access to evidence, and enhancing the communication of decisions. Extensive analyses of the literature and of documented decisionmaking processes around the globe were performed to explore what steps are currently used to make decisions with respect to context (from evidence generation to communication of decision) and thought process (conceptual components of decisions). Needs and methodologies available to support decisionmaking were identified to lay the groundwork for the EVIDEM framework. A framework was developed consisting of seven modules that can evolve over the life cycle of a healthcare intervention. Components of decision that could be quantified, i.e., intrinsic value of a healthcare intervention and quality of evidence available, were organized into matrices. A multicriteria decision analysis (MCDA) Value Matrix (VM) was developed to include the 15 quantifiable components that are currently considered in decisionmaking. A methodology to synthesize the evidence needed for each component of the VM was developed including electronic access to full text source documents. A Quality Matrix was designed to quantify three criteria of quality for the 12 types of evidence usually required by decisionmakers. An integrated system was developed to optimize data analysis, synthesis and validation by experts, compatible with a collaborative structure. The EVIDEM framework promotes transparent and efficient healthcare decisionmaking through systematic assessment and dissemination of the evidence and values on which decisions are based. It provides a collaborative framework that could connect all stakeholders and serve the healthcare community at local, national and international levels by allowing sharing of data, resources and values. Validation and further development is needed to explore the full potential of this approach.