Development and application of a generic methodology to assess the quality of clinical guidelines
Development and application of a generic methodology to assess the quality of clinical guidelines
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DOI：
10.1093/intqhc/11.1.21
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发表时间：
1999-02-01
影响因子：
2.6
通讯作者：
Moran, SE
中科院分区：
文献类型：
--
作者：
Cluzeau, FA;Littlejohns, P;Moran, SE
背景。尽管临床指南渗透到临床实践和卫生政策的各个方面，但对其改善患者护理能力的质疑仍然存在。我们已经设计并测试了一个通用的关键评估工具，它可以评估开发人员是否在创建指导方针时最小化了固有的偏差，并解决了有效实现设计的需求。描述指南质量建议预测指标的37个项目被分为三个维度，包括制定的严谨性、表述的清晰度（包括上下文和内容）和实施问题。该工具的易用性、可靠性和有效性在哮喘、乳腺癌、抑郁症和冠心病管理指南的国家样本上进行了测试，有120名评价者。得出了一个数值分数，以便对疾病内部和疾病之间的指南进行比较。该仪器具有可接受的信度（Cronbach's alpha系数为0.68-0.84；类内相关系数为0.82-0.90）。结果提供了一些有效性证据（评价者的维度得分与他们的整体评估之间的Pearson相关系数在维度1为0.49，维度2为0.63，维度3为0.40）。该文书可以区分国家准则和地方准则，并且易于应用。指南的表现存在差异，大多数指南在每个维度上都没有达到大多数标准。使用这一工具应鼓励开发人员制定更准确地反映相关研究证据的指导方针。使指导方针适应当地使用的潜在用户或团体可以应用该工具来帮助决定遵循哪一项指导方针。国家卫生服务执行局正在使用该工具来协助决定向联合王国国家卫生委员会推荐哪些指导方针。该方法构成了评估欧洲指南质量的通用方法的基础。
Background. Despite clinical guidelines penetrating every aspect of clinical practice and health policy, doubts persist over their ability to improve patient care. We have designed and tested a generic critical appraisal instrument, that assesses whether developers have minimized the biases inherent in creating guidelines, and addressed the requirements for effective implementation.Design. Thirty-seven items describing suggested predictors of guideline quality were grouped into three dimensions covering the rigour of development, clarity of presentation (including the context and content) and implementation issues. The ease of use, reliability and validity of the instrument was tested on a national sample of guidelines for the management of asthma, breast cancer, depression and coronary heart disease, with 120 appraisers. A numerical score was derived to allow comparison of guidelines within and between diseases.Results. The instrument has acceptable reliability (Cronbach's alpha coefficient, 0.68-0.84; intra-class correlation coefficient, 0.82-0.90). The results provided some evidence of validity (Pearson's correlation coefficient between appraisers' dimension scores and their global assessment was 0.49 for dimension one, 0.63 for dimension two and 0.40 for dimension three). The instrument could differentiate between national and local guidelines and was easy to apply. There was variation in the performance of guidelines with most not achieving a majority of criteria in each dimension.Conclusions. Use of this instrument should encourage developers to create guidelines that reflect relevant research evidence more accurately. Potential users or groups adapting guidelines for local use could apply the instrument to help decide which one to follow The National Health Service Executive is using the instrument to assist in deciding which guidelines to recommend to the UK National Health Sendee. This methodology forms the basis of a common approach to assessing guideline quality in Europe.