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医疗保健研究和质量机构临床实践指南的有效性:指南变得过时的速度有多快?
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
概括
临床实践指南很快就过时了,大约一半在六年内就过时了. 建议每三年定期重新评估,以确保指南的有效性和临床效用.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
- 基于证据的医学基于证据的医学.
背景情况:
- 临床实践指南对临床医生至关重要,但需要定期更新才能保持相关性.
- 目前缺乏评估指南有效性和确定更新频率的方法.
- 对指导方针过时率的实证数据是必要的,以告知最佳实践.
研究的目的:
- 评估美国医疗保健研究和质量局 (AHRQ) 17条临床实践指南的当前有效性.
- 估计临床实践指南变得过时的速度.
- 为了确定指南有效性的推重新评估间隔.
主要方法:
- 制定了确定何时需要更新指南的标准.
- 调查了最初的指导方针小组成员 (170名受访者,71%的响应率).
- 通过2000年3月进行文献搜索,以确定新的证据和指导方针.
主要成果:
- 超过四分之三的评估指南需要更新 (7大,6小).
- 生存分析表明,大约50%的指导方针在5.8年内过时.
- 估计90%的指导方针仍然有效的时间点是3.6年.
结论:
- 大多数AHRQ临床实践指南已经过时,需要更新.
- 准则应大约每三年重新评估其有效性,以确保临床相关性.
- 这项研究提供了指导方针过时的经验证据,并为更新时间表提供了信息.
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