权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

CREATING GUIDELINES THAT ADAPT TO LOCAL CONTEXTS

创建适应当地情况的指南

基本信息

批准号：
6627573
负责人：
Aziz A Boxwala
金额：
$ 23.9万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2001
资助国家：
美国
起止时间：
2001-01-22 至 2003-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/6627573
关键词：
cholesterol colorectal neoplasms computer assisted medical decision making computer system design /evaluation decision making diet therapy dietary lipid human data neoplasm /cancer therapy nutrition related tag statistics /biometry

项目摘要

DESCRIPTION (adapted from the Abstract): Clinical guidelines are advocated as a means to improve quality of care, reduce variations in practice, and increase cost-effectiveness of care. However, acceptance of guidelines and their actual impact on practice have been limited. Two apparently self-contradictory attributes, imprecise recommendations and well-specified recommendations (inapplicable in a local practice or to specific groups of patient), have been found as important causes of poor compliance with guidelines. We hypothesize that a solution to this problem is to design guidelines in a manner that focuses on objectives rather than institution-specific or context-specific practices, which can then be adapted to the latter in local settings. We propose to develop a formal methodology for authoring setting-independent clinical guidelines and for adapting them to specific clinical environments and patient populations. Professional societies, and regional, national, or international organizations can utilize this methodology to create setting- independent guidelines. Health care settings such as hospitals, clinics, and practice groups can adapt these guidelines to their contexts by adapting recommendations and decision criteria contained in the guideline to those local settings appropriately. At each decision point, different management options can be specified along with rationale and considerations for use in different subgroups of patients. Guidelines will be specified in a hierarchical manner, i.e., guidelines will be decomposed recursively into subguidelines that may be further divided into other subguidelines. Higher level subguidelines will specify conditions and actions in an "intentional" manner, in terms of objectives (like "reduce systolic blood pressure") rather than "extensionally," in terms of particular approaches to achieving the objective (e.g., "give beta-blocker"). The model will contain a specification for constraints that can be applied to subguidelines of setting-independent guidelines. These constraints limit allowed modifications to a guideline during adaptation in order to preserve the integrity of the setting-independent guideline. We will conduct a formative study to understand issues pertaining to authoring guidelines using this approach. Setting-independent guidelines will be created for problems in primary care practice. These guidelines will then be adapted to a particular primary care clinical setting. The potential impact of this approach on adherence to guidelines in that practice will also be evaluated. We will compare the acceptance of recommendations contained in guidelines that have been adapted to acceptance of recommendations contained in guidelines that have not been adapted.

说明(改编自摘要)：临床指南被提倡作为提高护理质量的一种手段，减少实践中的差异，提高护理的成本效益。然而，对准则的接受及其对实践的实际影响是有限的。两个明显自相矛盾的属性，不准确建议和明确的建议(不适用于当地的实践或特定的患者群体)，已经被发现是重要的准则遵从性差的原因。我们假设一个解决方案是这个问题是以一种专注于目标的方式设计指导方针而不是特定于机构或特定背景的做法，这可能会在当地环境中适应后者。我们建议开发一种与环境无关的创作形式化方法临床指南及其适用于特定临床环境的指南和病人群体。专业协会，以及地区、国家或国际组织可以利用这一方法来创建环境-- 独立的指导方针。医疗保健环境，如医院、诊所和实践小组可以通过调整这些指导方针来适应他们的环境准则中所载的建议和决定标准适当的本地设置。在每个决策点，不同的管理选项可以与使用的基本原理和注意事项一起指定不同的患者亚群。准则将以分层方式指定，即准则将递归地分解为子准则，这些子准则可以进一步划分为其他次指导方针。更高级别的次级准则将具体说明条件和在目标(如“减少”)方面，以“有意”的方式采取行动收缩压“)，而不是”延伸性的“，就具体而言实现这一目标的方法(例如，“给予β-受体阻滞剂”)。模型将包含可应用于的约束的规范制定次级指导方针--独立指导方针。这些限制限制了允许在改编期间对指南进行修改，以保存独立于环境的指导方针的完整性。我们将进行形成性研究，以了解与创作有关的问题使用此方法的指导方针。制定-独立的指导方针将是为初级保健实践中的问题而创建的。然后这些指导方针将是适应于特定的初级保健临床环境。潜在的影响关于遵守该实践中的指导方针的这种方法也将已评估。我们将比较以下各项建议的接受度经调整以接受所载建议的准则在尚未修改的指导方针中。