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医療研究機関と品質の臨床実務ガイドラインの有効性:ガイドラインがどれだけ早く時代遅れになるか?
P G Shekelle1, E Ortiz, S Rhodes
1RAND, 1700 Main St, PO Box 2138, Santa Monica, CA 90401, USA. shekelle@rand.org
JAMA
|September 27, 2001
まとめ
臨床実務ガイドラインはすぐに時代遅れになり,約半数は6年以内に時代遅れになります. ガイドラインの有効性と臨床的有用性を確保するために,3年ごとに定期的に再評価することが推奨されます.
科学分野:
- 医療サービス 研究 医療サービス
- 医療情報工学 医療情報工学
- 根拠に基づいた医学は,証拠に基づいた医療です.
背景:
- 臨床実務ガイドラインは,臨床医にとって不可欠ですが,関連性を維持するために定期的に更新する必要があります.
- ガイドラインの有効性を評価し,更新頻度を決定するための現在の方法は不足しています.
- ガイドラインの時代遅れ率に関する実証的なデータは,ベストプラクティスを伝えるために必要である.
研究 の 目的:
- 米国保健医療研究と品質庁 (AHRQ) の17の臨床実践ガイドラインの現在の有効性を評価する.
- 臨床実務ガイドラインが時代遅れになる割合を推定する.
- ガイドラインの有効性について,推奨される再評価間隔を定めること.
主な方法:
- ガイドラインの更新が必要な時期を特定するための基準を策定.
- 最初のガイドライン・パネルのメンバーを調査した (170人,回答率71%).
- 2000年3月まで,新しい証拠とガイドラインを特定するために,文献検索を行った.
主要な成果:
- 評価されたガイドラインの4分の3以上は,更新が必要でした (7大,6小).
- 生存率分析によると,約50%のガイドラインは5.8年以内に時代遅れになるという.
- ガイドラインの90%がまだ有効だった時期は,3.6年と推定されています.
結論:
- AHRQの臨床実務ガイドラインの大部分は時代遅れで,更新が必要である.
- ガイドラインの有効性は,臨床的関連性を確保するために,およそ3年ごとに再評価されるべきです.
- この研究は,ガイドラインの時代遅れに対する経験的証拠を提供し,更新スケジュールを通知します.
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