Publishing web-based guidelines using interactive decision models.
Publishing web-based guidelines using interactive decision models.
复制标题
使用交互式决策模型发布基于网络的指南。
DOI：
10.1046/j.1365-2753.2001.00271.x
复制
发表时间：
2001
影响因子：
2.4
通讯作者：
Owens,DK
中科院分区：
文献类型：
--
作者：
Sanders,GD;NeaseJr,RF;Owens,DK
Commonly used methods for guideline development and dissemination do not enable developers to tailor guidelines systematically to specific patient populations and update guidelines easily. We developed a web‐based system,ALCHEMIST, that uses decision models and automatically creates evidence‐based guidelines that can be disseminated, tailored and updated over the web. Our objective was to demonstrate the use of this system with clinical scenarios that provide challenges for guideline development. We used theALCHEMISTsystem to develop guidelines for three clinical scenarios: (1)Chlamydiascreening for adolescent women, (2) antiarrhythmic therapy for the prevention of sudden cardiac death; and (3) genetic testing for the BRCA breast‐cancer mutation.ALCHEMISTuses information extracted directly from the decision model, combined with the additional information from the author of the decision model, to generate global guidelines.ALCHEMISTgenerated electronic web‐based guidelines for each of the three scenarios. UsingALCHEMIST, we demonstrate that tailoring a guideline for a population at high‐risk forChlamydiachanges the recommended policy for control ofChlamydiafrom contact tracing of reported cases to a population‐based screening programme. We usedALCHEMISTto incorporate new evidence about the effectiveness of implantable cardioverter defibrillators (ICD) and demonstrate that the cost‐effectiveness of use of ICDs improves from $74 400 per quality‐adjusted life year (QALY) gained to $34 500 per QALY gained. Finally, we demonstrate how a clinician could useALCHEMISTto incorporate a woman’s utilities for relevant health states and thereby develop patient‐specific recommendations for BRCA testing; the patient‐specific recommendation improved quality‐adjusted life expectancy by 37 days. TheALCHEMISTsystem enables guideline developers to publish both a guideline and an interactive decision model on the web. This web‐based tool enables guideline developers to tailor guidelines systematically, to update guidelines easily, and to make the underlying evidence and analysis transparent for users.
