Models in the Development of Clinical Practice Guidelines
Models in the Development of Clinical Practice Guidelines
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DOI：
10.7326/m14-0845
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发表时间：
2014-12-02
影响因子：
39.2
通讯作者：
Feuer, Eric J.
中科院分区：
文献类型：
--
作者：
Habbema, J. Dik F.;Wilt, Timothy J.;Feuer, Eric J.
临床实践指南应基于来自主要研究的系统评价的最佳科学证据。然而，这些研究往往没有提供指南制定小组评估利益和危害之间权衡所需的证据。在这篇文章中，作者确定了4个领域，其中模型可以弥合已发表的证据和指南制定所需的信息之间的差距，应用有关疾病风险，诊断测试特性和治疗效果的新信息或更新信息;探索更完整的替代干预策略;评估一生中的益处和危害;并预测准则所针对的条件的结果。考虑使用建模作为弥合这些差距的方法（前提是模型是高质量的，并得到充分验证）。结直肠癌和乳腺癌筛查被用作例子，以显示这些目的的模型的效用。作者提出，当有强有力的主要证据可以为模型提供信息，但证据与指南组必须解决的问题之间存在关键差距时，建模研究是最有用的。在这些情况下，模型结果与系统评价的结果一起为医疗保健实践和政策提供信息。
Clinical practice guidelines should be based on the best scientific evidence derived from systematic reviews of primary research. However, these studies often do not provide evidence needed by guideline development groups to evaluate the tradeoffs between benefits and harms. In this article, the authors identify 4 areas where models can bridge the gaps between published evidence and the information needed for guideline development applying new or updated information on disease risk, diagnostic test properties, and treatment efficacy; exploring a more complete array of alternative intervention strategies; assessing benefits and harms over a lifetime horizon; and projecting outcomes for the conditions for which the guideline is intended. The use of modeling as an approach to bridge these gaps (provided that the models are high-quality and adequately validated) is considered. Colorectal and breast cancer screening are used as examples to show the utility of models for these purposes. The authors propose that a modeling study is most useful when strong primary evidence is available to inform the model but critical gaps remain between the evidence and the questions that the guideline group must address. In these cases, model results have a place alongside the findings of systematic reviews to inform health care practice and policy.