Evaluation of the Group Decision-Making Process of Clinical Guideline Panels

摘要 临床实践指南(CPGs)对于改善卫生保健提供和患者结局至关重要，以及 越来越多地与报销挂钩。到目前为止，等级(建议评估等级、 发展和评价)制度已经成为发展CPG的主导规范制度 并在美国和世界各地广泛使用。CPGs的发展是群体判断的产物。 令人惊讶的是，尽管群体判断对于发布指南很重要，但在以下方面所做的工作却很少 分析中央人民政府小组如何在职级制度内或职系外作出判断。因为这个年级是 考虑到发展CPG的最佳规范制度，我们假设小组的小组 判断将准确地反映等级关键标准(“线索”)与能力的关系 建议，在某种程度上被其他已知影响人们决策的因素所修改。至 为了解决我们的假设，我们将评估年级因素对群体判断过程与个人判断过程的影响 小组成员根据镜头型号(SA#1)。我们将用定性分析来补充这一分析 评估未正式包含在评分系统中的其他构件(SA1b)。在SA#2中，我们 将讨论背景因素和其他可能影响中央人民政府判断一致性的因素的作用 (例如，更多与社会相关的话题，更多样化的中央人民政府事务委员会，和/或有利益冲突的事务委员会将 在个人和群体判断之间产生更大的差异)。我们总共会研究14个中央人民政府小组， 这将产生约2,000条练习建议。 为了达到我们的短期目标，我们提出了一项旨在解释中央人民政府小组判决的创新研究 采用理论上的声透镜模型。我们的长期目标是提高中央人民政府专家组判决的准确性。通过 改善对中央人民政府判断程序的理解，拟议的研究将对 我们开发CPG的方式。 公共卫生和医疗保健融资都依赖于可靠、值得信赖的CPG。因此，它是最重要的 理解群体判断过程的重要性，这是制定CPG的基础。

ABSTRACT Clinical Practice Guidelines (CPGs) are essential to improve health care delivery and patient outcomes, and are increasingly tied to reimbursement. To date, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system has emerged as the leading prescriptive system for developing CPGs and is widely used both in the US and worldwide. Development of CPGs is the product of group judgment. Surprisingly, and despite the importance of group judgments for issuing guidelines, little work has been done to analyze how the CPG panels make their judgments within or outside GRADE system. Because the GRADE is considered the best prescriptive system for development of CPGs, we hypothesize that the panels' group judgments will accurately reflect a relationship between GRADE key criteria (“cues”) and the strength of recommendations, modified to some extent by other factors known to affect people's decision-making. To address our hypothesis, we will assess the impact of GRADE factors on group judgment process vs. individual panel members according to the lens model (SA#1). We will supplement this analysis with the qualitative evaluation of additional constructs that are not formally included in the GRADE system (SA1b). In SA#2, we will address the role of contextual factors and other factors that may affect the consistency of CPG judgments (e.g., more socially relevant topics, greater diversity of CPG panels, and/or panels with conflict of interest will generate greater discrepancy between individual and group judgments). In total, we will study 14 CPG panels, which will generate about 2,000 practice recommendations. To meet our short-term objectives, we propose an innovative study aiming to explain CPG panel judgments using theoretically sound lens model. Our long-term objective is to improve CPG panel judgments accuracy. By improving understanding of CPG judgment processes, the proposed study will exert sustained impact on the way we develop CPGs. Both public health and healthcare financing depend on reliable, trustworthy CPGs. Therefore, it is of utmost importance to understand group judgment processes that are foundations of the CPG development.