Can reflective multicriteria be the new paradigm for healthcare decision-making? The EVIDEM journey.
Can reflective multicriteria be the new paradigm for healthcare decision-making? The EVIDEM journey.
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DOI：
10.1186/s12962-018-0116-9
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Cellier MS
中科院分区：
文献类型：
--
作者：
Goetghebeur MM;Cellier MS
多种技术、程序和计划要求为医疗干预的优先顺序做出公平的决定。关于什么是合法决定，有不同的观点，这既取决于程序，也取决于适用的理由。目前的方法侧重于技术方面，而缺乏支持决策与医疗保健系统的同情动力保持一致的方法。该框架是基于对医疗保健系统的基础、决策背后的推理和公平程序的分析而制定的。反思性多标准的概念诞生了：它假设决策者在植根于医疗体系同情动力的通用解释框架的指导下，能够敏锐地推理，提高对其动机的认识，并增加决策的合法性。最初的框架是通过一个非营利性组织(EVIDEM协作，2006-2017)提供的，以促进其与思想领袖和利益攸关方在开放源码哲学中的发展。发展是为决策者的现实生活需要量身定做的，并利用了几个知识领域，包括保健伦理、循证医学、保健经济学、保健技术评估和多标准办法。第10版框架建立在四个维度上：(1)医疗保健系统的普遍推动力，(2)推理、价值观和伦理，(3)关于干预的证据和知识，以及(4)变革过程。该框架的数学方面旨在帮助澄清、表达和分享个人推理；这种对数字的非常规使用需要文化变化，需要慢慢地逐步采用。该框架包括四个便于改编和操作的工具：(A)概念和可操作性，(B)改编和试点，(C)证据矩阵，(D)推理的数学表示。应用程序在所有类型的医疗干预、各级决策和全球范围内都很有用。通过澄清他们的推理，同时让决策者了解医疗保健系统的动力，反思性多标准提供了一种有效的方法来增加决策的合法性。除了作为一种工具，EVIDEM首创的反思性多标准旨在改变我们对医疗干预的价值以及它们如何为相关、公平和可持续的医疗体系做出贡献的愿景。本文的在线版本(10.1186/s12962-0180116-9)包含向授权用户提供的补充材料。
Multiple technologies, procedures and programs call for fairly-based decisions for prioritization of healthcare interventions. There is a diversity of perspectives of what constitutes a legitimate decision, which depends on both the process and the reasoning applied. Current approaches focus on technical aspects while methods to support alignment of decisions with the compassionate impetus of healthcare systems is lacking. The framework was developed based on an analysis of the foundations of healthcare systems, the reasoning underlying decisions and fair processes. The concept of reflective multicriteria was created: it assumes that decisionmakers guided by a generic interpretative frame rooted in the compassionate impetus of healthcare systems, can sharpen their reasoning, raise awareness of their motivation and increase legitimacy of decisions. The initial framework was made available through a not for profit organization (the EVIDEM Collaboration, 2006–2017) to stimulate its development with thought leaders and stakeholders in an open source philosophy. Development was tailored to the real-life needs of decisionmakers and drew on several domains of knowledge including healthcare ethics, evidenced-based medicine, health economics, health technology assessment and multicriteria approaches. The 10th edition framework builds on four dimensions: (1) the universal impetus of healthcare systems, (2) reasoning, values and ethics, (3) evidence and knowledge on interventions, and (4) a transformative process. Mathematical aspects of the framework are designed to help clarify, express and share individual reasoning; this non-conventional use of numbers requires a cultural change and needs to be phased in slowly. The framework includes four tools for easy adaptation and operationalization: (a) concepts and operationalization, (b) adapt and pilot, (c) evidence matrix, (d) mathematical representation of reasoning. Application is useful throughout all types of healthcare interventions, for all levels of decision, and across the globe. By clarifying their reasoning while keeping decisionmakers aware of the impetus of healthcare systems, reflective multicriteria provides an effective approach to increase the legitimacy of decisions. Beyond a tool, reflective multicriteria pioneered by EVIDEM is geared to transform our vision of the value of healthcare interventions and how they might contribute to relevant, equitable and sustainable healthcare systems. The online version of this article (10.1186/s12962-018-0116-9) contains supplementary material, which is available to authorized users.
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10.1210/jc.2012-3888
发表时间：
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