Evidence-based health policy: context and utilisation
Evidence-based health policy: context and utilisation
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DOI：
10.1016/s0277-9536(03)00166-7
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发表时间：
2004-01-01
影响因子：
5.4
通讯作者：
Upshur, REG
中科院分区：
文献类型：
--
作者：
Dobrow, MJ;Goel, V;Upshur, REG
循证决策的核心是说明决策的理由。在从个人临床到人口政策层面的转变中，决策环境变得更加不确定、多变和复杂。为了解决这个问题，我们已经制定了一个概念框架，以证据为基础的决策，重点是如何上下文的影响，什么构成证据，以及如何利用证据。我们提出了两个不同的方向对什么构成证据，代表不同的证据和背景之间的关系。我们还根据环境对循证决策的影响方式对决策环境进行了分类。此外，我们援引循证决策轴的概念来描述证据和背景之间的关系，因为我们从循证医学循证卫生政策。由此，我们认为，如何利用证据可能比如何定义证据更重要。基于研究和知识利用文献，我们提出了一个过程模型的证据利用，这形成了基于上下文的循证决策的概念框架的基础。概念框架试图捕捉上下文在证据的引入、解释和应用中所发挥的作用。我们用结直肠癌筛查政策制定的例子来说明这一框架。(C)2003爱思唯尔科技有限公司版权所有。
Evidence-based decision-making is centred on the justification of decisions. In the shift from an individual-clinical to a population-policy level, the decision-making context becomes more uncertain, variable and complex. To address this we have developed a conceptual framework for evidence-based decision-making, focusing on how context impacts on what constitutes evidence and how that evidence is utilised. We present two distinct orientations towards what constitutes evidence, representing different relationships between evidence and context. We also categorise the decision-making context based on the ways in which context impacts on evidence-based decision-making. Furthermore, we invoke the concept of axes of evidence-based decision-making to describe the relationship between evidence and context as we move from evidence-based medicine to evidence-based health policy. From this, we suggest that it may be more important how evidence is utilised than how it is defined. Based on the research and knowledge utilisation literature, we present a process model of evidence utilisation, which forms the basis for the conceptual framework for context-based evidence-based decision-making. The conceptual framework attempts to capture the role that context plays in the introduction, interpretation and application of evidence. We illustrate this framework with examples from policy development for colorectal cancer screening. (C) 2003 Elsevier Science Ltd. All rights reserved.