The Construction Of Evaluation System For Chinese Clinical Practice Guideline

[Objective] In the 3P background of advocating the prevention, prediction and personal treatment,clinicians and evidence-based decision-making are increasingly close. Clinical practice guidelines for specific clinical problems analysis and evaluate evidence of the latest research, and put forward specific recommendations. So it's of great importance to standardize the clinical diagnosis and treatment process, and provide the basis evidence for clinical decision making. However, there is a large number of clinical guidelines having problems in quality. And it becomes the biggest obstacle to use. The purpose of this research is using qualitative and quantitative methods to develop a evaluation system with high reliability and validity of clinical guidelines, based on a set of international clinical standards, in line with the characteristics of China's clinical guidelines. The research lay the foundation for the development and evaluation of Chinese localization clinical guidelines.[Methods] In this study, collecting research data about international clinical guidelines evaluation theory and practice, and use literature review and bibliometric methods to analysis the contents of documents, then select the most important factorial dimensions related to clinical guidelines evaluation; by the user needs research, selecting the special index for Chinese clinical guidelines, the results was compiled to the construction of preliminary clinical guidelines evaluation system; using the Delphi method to modify the preliminary evaluation system further; the combinative use of AHP and fuzzy comprehensive evaluation is to calculating the index weight, and ultimately determine the full clinical guidelines evaluation system.[Results] The main results of this study are as follows:(1) The established Chinese clinical guideline evaluation system include 10 dimensions: guideline development staff, strictness of guideline development, external review, transparency of guideline development, effective management of interest conflicts, applicability of guideline, updates of guideline, publishing of guideline, evaluation of implementation. There are 33 indicators in total.(2) Through the Delphi method to evaluate content validity of indicators(item of importance, accuracy, clarity and operation). The authority coefficient is 0.881, and the evaluation results of the comparison of convergence Kendall coefficient W=0.409, p=0.000<0.05. After the content validity analysis, the entire evolution system was cut in the number. Merged and deleted four dimensions, removed four indicators, and ultimately determine the evaluation system of six dimensions, and 29 indicators.(3) The combination of AHP and fuzzy comprehensive evaluation is used to calculating the index weight. Indicators of great importance are as follows: “clinical guidelines formulated by the authoritative department organization or initiated clinical guidelines issued to obtain the field by the authoritative departments approved", "clinical guidelines is take in to all the current relevant research literature as the basis of clinical evidence and recommendations", "recommendations are clear, easy to identify and cannot produce ambiguity", "pay attention to the wording of the use, unified specification language" and " clinical guidelines was published in the past 3 years,and clinical guidelines cite the latest original research evidence" and so on.[ Conclusions] The main conclusions of this study are as follows:(1) Through literature research and user demand investigation,analysis the domestic and international clinical guidelines and the evaluation of clinical guidelines, develop an evaluation system for Chinese clinical guidelines with localization characteristics.(2) Some indicators of the evaluation system are concerned with the development of the frontier, focusing on the forward-looking and long-term goals of the project, suitable for the "evaluation and promotion of construction" type of evaluation.(3) The establishment of the evaluation system of clinical guidelines should pay attention to scientific, comprehensive, objective and specific principles;(4) The combination of qualitative methods and quantitative evaluation of expert consultation makes this research more scientific and rigorous;(5) The deficiency and the further research direction, which is, according to the different types and disciplines of clinical guidelines to increase and improve more evaluation indicators, and through the scientific path of evaluation system is transformed into universal tools.