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

摘要 临床实践指南（CPG）对于改善医疗服务和患者结局至关重要， 越来越依赖于偿还。到目前为止，GRADE（建议评估分级， 发展和评估）系统已成为发展CPG的主要规范系统 并且在美国和世界范围内被广泛使用。CPGs的发展是群体判断的产物。 令人惊讶的是，尽管群体判断对发布指导方针很重要，但几乎没有做过什么工作， 分析CPG小组如何在GRADE系统内外做出判断。因为等级是 被认为是最好的规范系统的发展CPGs，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”）和 这些建议在一定程度上受到其他已知影响人们决策的因素的影响。到 为了解决我们的假设，我们将评估GRADE因素对群体判断过程与个人判断过程的影响。 根据透镜模型（SA#1）的小组成员。我们将补充这一分析与定性 评价未正式纳入GRADE系统的其他结构（SA 1b）。在SA#2中，我们 我会探讨背景因素及其他可能影响中央政府判断一致性的因素 (e.g.,更多与社会相关的主题，更多样化的中央政府小组，和/或有利益冲突的小组将 在个人和群体判断之间产生更大的差异）。我们总共将研究14个CPG面板， 这将产生大约2,000个实践建议。 为了实现我们的短期目标，我们提出了一个创新的研究，旨在解释中央人民政府小组的判断 使用理论上的声透镜模型。我们的长期目标是提高CPG面板判断的准确性。通过 提高对中央人民政府判断过程的理解，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， 了解作为CPG发展基础的群体判断过程的重要性。

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.