临床实践指南实施效果评价工具的系统评价  

Tools for evaluating the implementation effect of clinical practice guidelines:a systematic review

作　　者：邹锟 何思颐 杨楠 曾力楠[1,2,3,4] 李海龙[1,2,3,4] 黄亮 易秋莎 张明月[6] 王强[7] 张伶俐 ZOU Kun;HE Siyi;YANG Nan;ZENG Linan;LI Hailong;HUANG Liang;YI Qiusha;ZHANG Mingyue;WANG Qiang;ZHANG Lingli(Department of Pharmacy,West China Second University Hospital,Sichuan University,Chengdu 610041,P.R.China;Evidence-Based Pharmacy Center,West China Second University Hospital,Sichuan University,Chengdu 610041,P.R.China;NMPA Key Laboratory for Technical Research on Drug Products in vitro and in vivo Correlation,Chengdu 610041,P.R.China;Key Laboratory of Birth Defects and Related Diseases of Women and Children,Sichuan University,Ministry of Education,Chengdu 610041,P.R.China;West China School of Pharmacy,Sichuan University,Chengdu 610041,P.R.China;School of Stomatology,Chinese Medical University,Shenyang 110002,P.R.China;Medical Management Service Guidance Center,National Health Commission of the People’s Republic of China,Beijing 100044,P.R.China;Chinese Evidence-based Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西第二医院药学部,成都610041 [2]四川大学华西第二医院循证药学中心,成都610041 [3]国家药品监督管理局药物制剂体内外相关性技术研究重点实验室,成都610041 [4]出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [5]四川大学华西药学院,成都610041 [6]中国医科大学口腔医学院,沈阳110002 [7]国家卫生健康委医疗管理服务指导中心,北京100044 [8]四川大学华西医院中国循证医学中心,成都610041

出　　处：《中国循证医学杂志》2024年第6期693-699,共7页Chinese Journal of Evidence-based Medicine

基　　金：国家卫健委医管中心2022年委托项目(编号:医管中心标准管理处〔2022〕047号)。

摘　　要：目的梳理总结国内外临床实践指南实施效果评价工具现状,为制定通用的指南实施效果评价工具提供参考。方法计算机检索PubMed、Embase、CNKI等7个生物医学文献数据库和2个学术网站,检索时限均为建库至2022年6月,纳入指南实施效果评价工具的理论和实证研究。由2名研究者根据纳入与排除标准独立筛选文献、提取数据后,基于实施科学RE-AIM理论框架,采用主题分析法,初拟指南实施效果的评价框架和备选条目清单。结果最终纳入208篇文献,筛选出8个目前较为成熟的涉及评价指南实施效果的工具。现有指南实施效果评价多针对具体疾病;主要关注指南使用者对指南的认知、态度和依从性,侧重于评价指南的实施过程及其影响因素,较少关注终端效果;较少采用成熟的理论框架,评价角度单一,评价维度较少。初拟指南实施效果评价工具的框架和备选条目清单,包含6个一级指标、12个二级指标和41个三级指标。结论目前尚缺乏一套基于成熟理论、多视角、通用的指南实施效果评价工具。基于实施科学RE-AIM理论,拟订指南实施效果评价框架和备选条目清单,可以为指南实施效果评价工具的开发提供参考。Objective To summarize the evaluation tools for the implementation effect of clinical practice guidelines(CPGs),to inform and support the evidence-based development of a general tool for the evaluation of implementation effect of CPGs.Methods Seven biomedical literature databases,including PubMed,Embase and CNKI,and two academic websites,were searched from establishment to June 2022.Theoretical and empirical research on the evaluation tools of the implementation effect of CPGs were included.Two researchers independently screened literature and extracted data according to the inclusion and exclusion criteria.Based on the Implementation Science RE-AIM theoretical framework,an evaluation framework and a list of alternative items of the implementation effect of the CPGs were initially drawn up by thematic synthesis methods.Results A total of 208 articles were included,and 8 mature evaluation tools related to the implementation effect of guidelines were selected.Current research on the evaluation of the implementation effect of CPGs mainly focused on single diseases,with concern of the cognition,attitude and compliance of users to CPGs,and the process of the implementation of CPGs and factors affecting the implementation effect of CPGs.There were limitations such as a lack of evaluation on the terminal effect of the implementation of CPGs,the rare use of mature theoretical frameworks,the use of single evaluation perspectives,and inclusion of limited evaluation dimensions.The initial proposed evaluation framework contains a list of alternative items with 6 primary indicators,12 secondary indicators and 41 tertiary indicators.Conclusion Currently,there is a lack of a comprehensive,multi-perspective,mature theory based,general tool for the evaluation of implementation effect of CPGs.The framework and the list of alternative items for the evaluation of implementation effect of CPGs based on the implementation science RE-AIM theory can inform and support the development of a tool for the evaluation of implementation effect

关 键 词：临床实践指南 实施效果 评价工具 系统评价 

分 类 号：R4[医药卫生—临床医学]