Clinical and Public Health Guidelines最新文献

Since 1999, the Registered Nurses' Association of Ontario (RNAO) has developed best practice guidelines (BPG) to promote consistency and quality of evidence-based care and improve patient, organization and health system outcomes. A distinguishing feature of RNAO's BPG development portfolio is its integration within RNAO's three-pillar BPG programme. This programme supports health service and academic organizations, Best Practice Spotlight Organizations® (BPSO®), to systematically implement, monitor and evaluate BPGs. Through formal partnerships with these organizations, the BPSO network extends the reach of the BPG programme and provides RNAO with direct feedback from end users, strengthening the relevance of future guideline editions. This article describes RNAO's integrated BPG development methods, outlining how evidence-based recommendations are made to support organizations implementing BPGs. Following extensive pre-development work to shape the purpose and scope of each guideline, an interprofessional expert panel that includes people with lived experience is appointed. Using the Grading of Recommendations, Assessment, Development and Evaluation methods, the expert panel prioritizes research questions and systematic reviews are conducted to determine strong or conditional recommendations. Good practice statements are also included and resources to support guideline implementation and evaluation are formulated including fact sheets, RNAO Clinical Pathways™ and evaluation measures. Draft guidelines undergo external review to ensure relevance and usability. To best serve the needs of organizations implementing BPGs, ongoing efforts are being made to keep RNAO's methods up-to-date and incorporate evaluation data from implementing organizations into the guideline development process.

The concept of clinical practice guideline has existed for over 30 years, but guidelines still face numerous limitations, including low methodological quality, inadequate reporting transparency, slow implementation, and infrequent updates [1, 2]. There are several barriers in the dynamics between the different steps of the entire process, ranging from guideline development to implementation for which improvements are warranted [3, 4]. The establishment of a cohesive and well-coordinated guideline ecosystem could help to eliminate many barriers across the entire process from development to implementation and address the existing challenges.

The guideline ecosystem encompasses more than the above steps, but we believe these seven are the most fundamental ones and deserve particular attention. Each of the steps will require a thorough evaluation of the current situation, as well as the development of a standardised framework. A standardised framework will outline the relationships between the different steps of the guideline ecosystem, which in turn will help to promote the development, implementation, and updating of high-quality guidelines in a coordinated and transparent manner.

Nan Yang: conceptualization, writing — original draft, visualization. Dong Roman Xu: writing — review and editing, supervision Janne Estill: methodology, writing — review and editing. Yaolong Chen: conceptualization, writing — review and editing, supervision, funding acquisition. All authors have read and approved the final manuscript.

The authors declare no conflict of interest. Yaolong Chen is the cofounder and cochair of RIGHT (Reporting Items for Practice Guidelines in Healthcare).

All relevant data are within the manuscript.

The importance of incorporating economic evidence (EE) such as resource use, cost or cost-effectiveness evidence into Clinical Practice Guidelines (CPG) is being increasingly recognised by decision makers, including healthcare providers and policy makers. Yet, this is a complex and resource-intensive process. EE can influence recommendations formulated about interventions in CPGs, especially when the desirable and undesirable effects are balanced. A group of methodologists, including health economists, in GuíaSalud (the organisation of the Spanish National Health System (NHS) that coordinates the national CPG Programme), has made important advances in the development of methodological guidance for how to develop evidence-based recommendations. In this article, we present an algorithm for informing decisions about incorporating EE in CPGs. The algorithm has three stages: (1) prioritise clinical questions in the CPG according to the influence that EE is expected to have on recommendations; (2) obtain EE for clinical questions that have been prioritised via a systematic review and/or a de novo economic evaluation; and (3) use EE to inform recommendations in CPG. We show how the algorithm was applied in the development of GuíaSalud's CPG for the management of chronic primary pain. In doing so, we provide specific guidance on how the algorithm could be applied using concrete examples. We show how this algorithm helps to make the process of incorporating EE into CPGs agile, dynamic and reproducible.