Evaluation and adaptation of clinical practice guidelines.
Evaluation and adaptation of clinical practice guidelines.
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DOI：
10.1136/ebn.8.3.68
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发表时间：
2005-07-01
影响因子：
--
通讯作者：
Harrison, Margaret B
中科院分区：
文献类型：
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作者：
Graham, Ian D;Harrison, Margaret B
临床实践指南是“系统开发的声明，以帮助医生和患者决定针对特定临床情况的适当医疗保健。1它们旨在提供关于如何提供医疗保健服务的简明说明。2临床实践指南最重要的好处是其改善护理质量或过程以及患者结局的潜力。越来越多的临床医生和临床管理人员必须从众多的，有时是不同的，有时是矛盾的指南中选择。4对现有准则质量的关切使这一情况更加复杂。5-11事实上，采用有效性有问题的指南可能导致使用无效的干预措施，低效使用稀缺资源，也许最重要的是，对患者造成伤害。12 13确定哪些指南是值得采用的优质产品可能令人生畏。应尽一切努力查明经过严格制定的现有准则，并加以采纳或调整，以供当地使用。然而，组织和临床医生应该仔细审查制定指南的方法，以及建议的内容和实用性。即使是著名的专业团体或政府机构制定的指南也不应免于这种审查，因为这些指南的质量可能低于标准。10实践指南评估和适应周期14 15是组织和决定采用哪些高质量指南的框架（图）。虽然该周期最初是供希望实施最佳实践的组织和团体使用的，但该过程的大多数步骤也有助于指导临床医生对指南的评估。本用户指南将描述确定、批判性评价和采用或修改指导方针以供当地使用的战略。
Clinical practice guidelines are ‘‘systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.’’1 They are intended to offer concise instructions on how to provide healthcare services. 2 The most important benefit of clinical practice guidelines is their potential to improve both the quality or process of care and patient outcomes. 3 Increasingly, clinicians and clinical managers must choose from numerous, sometimes differing, and occasionally contradictory, guidelines. 4 This situation is further complicated by concerns about the quality of available guidelines. 5–11 Indeed, adoption of guidelines of questionable validity can lead to the use of ineffective interventions, inefficient use of scarce resources, and perhaps most importantly, harm to patients. 12 13 Determining which guidelines are quality products worthy of adoption can be daunting. Every effort should be made to identify existing guidelines that have been rigorously developed and to adopt or adapt them for local use. 12 However, organisations and clinicians should scrutinise the methods by which the guidelines were developed, as well as the content and utility of the recommendations. Even guidelines developed by prominent professional groups or government bodies should not be exempt from this scrutiny as it has been shown that these guidelines may be of substandard quality. 10 The Practice Guidelines Evaluation and Adaptation Cycle14 15 is a framework for organising and making decisions about which high quality guidelines to adopt (figure). Although the cycle was originally intended for use by organisations and groups wanting to implement best practice, most steps of the process are also helpful in guiding evaluation of guidelines by individual clinicians. This Users’ guide will describe strategies for identifying, critically appraising, and adopting or adapting guidelines for local use.