临床实践指南制订方法——指南的实施工具

Methodology for clinical practice guidelines--implementation tools of guidelines

目的系统检索,聚焦指南实施工具或理论。方法检索Pubmed、Web of science、CNKI等数据库并补充检索Shiffman RN及Gagliardi AR的相关文章。结果三个相关工具分别是:指南可实施性评价工具(GLIA),指南实施的概念框架及指南实施计划清单(checklist for guideline implementation planning)。GLIA主要用于两类人群,于指南制订者可帮助其规范指南推荐意见撰写发布及设计实施策略;于证据使用者可以帮助其选择指南、分析推荐意见实施可能遇到的障碍因素、促进指南实施讨论:可适当参考引用以上工具方法,并结合实施性研究理论与方法及具体指南实施的影响因素综合分析。指南实施概念框架包括适应性、可用性、有效性、应用性、可沟通性、可调节性,可用于指南实施性的评价。指南实施计划清单用于指南发布后实施前的准备工作提供结构性建议。结论指南实施是个复杂的过程,应用合理的理论或工具可促进指南实施的效率已保证指南实施的效果。专业实施研究相关人员应参与到具体指南实施过程中。

Objective To determine the tool or theory for guideline implementation. Method We searched Pubmed,Web of science, CNKI, etc supplemented papers published by Shiffman RN and Gagliardi AR. Result Three tools identified.The GuideLine Implementability Appraisal(GLIA) is intended to provide information about a guideline’s implementability to(1) A guideline authoring group, which may decide to modify content to improve implementability;(2) Those individuals who choose guidelines for application within a health care delivery system, in which case, GLIA can be used to anticipate potential problems in implementation. The implementability framework included 22 elements organized in the domains of adaptability,usability, validity, applicability, communicability, accommodation, implementation, and evaluation.Developers or users can apply the Guideline implementation planning checklist to prepare for and/or undertake guideline implementation. Conclusion Guideline implementation is complex, and basing on guideline implementation theory or tool is necessary. Guideline implementation would benefit from including knowledge translation experts.