中国临床路径的证据来源调查  

An investigation of the sources of evidence of the clinical pathways in China

作　　者：荀杨芹 成鹏[4] 李秀霞 韦当[2] 姚亮[5] 潘蓓 闫沛静[6] 许可 李亚男 郭天康[6] 杨克虎[2,3] XUN Yangqin;CHENG Peng;LI Xiuxia;WEI Dang;YAO Liang;PAN Bei;YAN Peijing;XU Ke;LI Yanan;GUO Tiankang;YANG Kehu(School of Public Health,Lanzhou University,Lanzhou,730000,P.R.China;Evidence-Based Medicine Center,Lanzhou University,Lanzhou,730000,P.R.China;Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province,Lanzhou,730000,P.R.China;Department of Orthopedics,Second Hospital of Lanzhou University,Lanzhou,730030,P.R.China;Chinese Medicine Faculty of Hong Kong Baptist University,HongKong,999077,P.R.China;Institution of Clinical Research and Evidence Based Medicine,Gansu Provincial Hospital,Lanzhou,730000,P.R.China)

机构地区：[1]兰州大学公共卫生学院,兰州730000 [2]兰州大学循证医学中心,兰州730000 [3]甘肃省循证医学与临床转化重点实验室,兰州730000 [4]兰州大学第二医院骨科/甘肃省骨关节疾病研究重点实验室,兰州730000 [5]香港浸会大学中医药学院临床部,香港999077 [6]甘肃省人民医院临床循证医学研究所,兰州730000

出　　处：《中国循证医学杂志》2018年第10期1032-1036,共5页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金项目(编号:81673825)

摘　　要：目的分析目前我国临床路径证据的来源情况。方法从国家卫生和计划生育委员会网站获取已批准的临床路径,由2名研究者独立提取资料,对路径的发布时间、关注疾病、证据报告等方面进行描述性分析。对路径诊断和治疗部分不同证据发表与路径发布时间间隔进行方差分析并使用LSD法进行两两比较。结果临床路径引用证据的类型主要为指南、教科书、标准指标和共识意见。其中约80%引用了临床实践指南,36%引用了教科书。每个路径引用证据数量的中位数为2个。85%的证据报告了其发表时间,路径发布与证据发表的平均时间间隔为5.2年,在时间间隔大于15年的证据中占比最大的为教科书。除教科书对比标准指标的时间间隔外,其他证据发表与路径发布时间间隔的两两比较均有显著差异(P<0.05)。结论我国临床路径的证据类型选择基于循证医学的理念,但引用证据的时间范围跨度较大。制定临床路径时,要重视最新的研究证据,增强临床路径制订过程的透明性,采用证据质量评价标准对引用证据进行评价和选择。Objectives To investigate sources of evidence of the clinical pathways approved by the Chinese government. Methods The approved clinical pathways were obtained from the website of the National Health and Family Planning Commission. Two reviewers independently extracted the basic information, approval date, types of evidence of the clinical pathways and time of evidence. The variance analysis was performed for the diagnosis and treatment parts of clinical pathways and the LSD method was further used for comparison. Results The main types of evidence were guidelines, textbooks, standard indicators and consensus views. Approximately 80% of the pathways cited clinical practice guidelines and 36% cited the textbooks. The median number of evidence for each clinical pathway was 2.Approximately 85% of the evidence could be obtained the time when the evidence published. The average time interval（between the time when the pathways released and the time when the evidence published） was 5.2 years. Specifically,t extbooks constituted the largest proportion in all evidence that was over 15 years of time interval. In addition to the textbook comparison standard indicators, there were significant differences in time interval between guidelines or consensus and textbooks or standard indicators. Conclusions The evidence types selection is based on the concept of evidence-based medicine, yet the time span of the referred evidence is larger. Therefore, developing clinical pathways not only need to refer to the latest research evidence comprehensively and enhance transparency of clinical pathways, but also use evidence quality evaluation standards to evaluate and select the referred evidences.

关 键 词：临床路径 循证医学 证据 

分 类 号：R-03[医药卫生]