指南临床适用性评价实证研究:以糖尿病指南临床适用性评价为例

An empirical study on the evaluation of the clinical applicability of the guideline for diabetes

目的通过实证研究评价《中国2型糖尿病防治指南(2017版)》的适用性,并建立数据分析和结果报告模型,为指南临床适用性评价和更新提供参考依据。方法采用横断面调查方法,分别从已开展糖尿病相关诊治工作的医疗机构,每家抽取老年科、内分泌科、肾脏科或相关科室医生各6~8人。通过现场填写纸质版问卷,或通过电子问卷对未到现场者进行调查。对调查对象的基本特征、各维度评分、指南获取途径和影响实施因素进行描述性分析。采用Kruskal-Wallis秩和检验和Nemenyi检验进行多组比较和两两比较。采用多重线性回归方法并结合逐步回归筛选出各评分的影响因素。结果本次调查共收集问卷725份,有效问卷722份,有效回收率99.6%。评分结果显示,可获得性评分最低,可接受性评分最高。多组比较和多重线性回归分析结果显示,对指南熟悉程度是各评分的影响因素(P<0.05)。指南获取途径主要包括:学术会议(52.1%)、微信(45.4%)、生物医学文献数据库(43.5%)。调查对象中有139人认为该指南存在实施障碍(19.3%),其中认为实施障碍为医务人员因素、患者因素和环境因素的分别有136人(18.8%)、134人(18.5%)和133人(18.4%)。结论本研究建立了指南适用性评价的数据分析和结果报告模型,能为指南的制/修订提供数据支持。

Objectives To establish statistical analysis and result reporting model for evaluation of the applicability of the clinical guidelines. We conducted an empirical study for clinical guidelines for the prevention and treatment of type 2 diabetes in China. Methods A cross-sectional survey was conducted to select 6 to 8 doctors in geriatric, endocrinology, nephrology or related departments from medical institutions. The questionnaire was filled by doctors at a conference and electronic questionnaires were sent to those who did not attend the conference. Descriptive analysis was carried out for characteristics of evaluators, scores of each dimension, access to guidelines and factors affecting implementation. The Kruskal-Wallis rank-sum test and Nemenyi test were used for multi-group comparison and pairwise comparison. Multiple linear regressions with the stepwise strategy were used to screen out the association factors.Results A total of 725 questionnaires were collected in this survey. There were 722 valid questionnaires with an active recovery rate of 99.6%. The results showed the accessibility score was lowest and the acceptability score was highest. The results of multi-group comparison and multiple linear regression analysis showed that familiarity with the guidelines was the influencing factor of each score(P<0.05). The guidelines were primarily obtained from academic conferences(52.1%),WeChat(45.4%), and biomedical literature databases(43.5%). Among the evaluators, 44(41.9%) believed that there were implementation obstacles in the guidelines, among which 136(18.8%), 134(18.5%) and 133(18.4%) believed that implementation obstacles were medical personnel factor, patient factor and environmental factor. Conclusions In this study, a data analysis and result report model for the assessment of the applicability of the guidelines is established to provide evidence for the development/revision of the guidelines.