知證衛生決策工具之九——系統評價結果的適用性評價*_《中國循證醫學雜志》

作者：

John N Lavis ¹ , Andrew D Oxman ² , Nathan M Souza ³ , Simon Lewin ⁴ , Russell L Gruen ⁵ , Atle Fretheim ⁶

關鍵詞：

DOI：

10.7507/1672-2531.20100417

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衛生體系的差異往往使得在某種環境下適用的衛生政策或規劃不適用于其他情況，或這種差異使相同的衛生政策或規劃在不同環境下起作用的方式不同，甚至使其效果大相徑庭。因此，決策者及其支持者所面臨的最大挑戰是需弄清支持某一決策的研究證據是否適用于他們所處的環境。系統評價通過總結各種背景下的研究證據而使這一問題迎刃而解。但許多系統評價并未對描述原始研究的實施背景。本文建議用下面幾個問題來指導決策者評價系統評價結果在特定環境下的適用性：① 系統評價納入研究的實施背景是否相同或研究結果是否能在不同環境下或不同時期內保持一致性？② 有可能明顯改變決策的可接受性和可行性的現實條件和制約因素是否存在重要差異？③ 在衛生系統制度方面是否存在重要差異從而意味著某種決策不能以同樣的方式起作用？④ 基線情況是否存在重要差異以至于產生不同的絕對效應，盡管相對效應是一致的？⑤ 從決策、實施、監測及評估中還能得到哪些啟示？盡管有理由推斷某決策在某特定環境下的作用可能不同，但我們幾乎總是可以從對各種可能的決策方案及其實施、監測、評估方法的系統評價中獲得一些啟示。

引用本文： John N Lavis,Andrew D Oxman,Nathan M Souza,Simon Lewin,Russell L Gruen,Atle Fretheim. 知證衛生決策工具之九——系統評價結果的適用性評價*. 中國循證醫學雜志, 2010, 10(4): 398-404. doi: 10.7507/1672-2531.20100417 復制

1.	Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst. In Press.
2.	Lavis JN, Oxman AD, Grimshaw J, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 7. Finding systematic reviews. Health Res Policy Syst. In Press.
3.	Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 8. Deciding how much confidence to place in a systematic review. Health Res Policy Syst. In Press.
4.	Oxman AD, Lavis JN, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 10. Taking equity into consideration when assessing the findings of a systematic review. Health Res Policy Syst. In Press.
5.	Dans AL, Dans LF, Guyatt GH. Applying results to individual patients. In Users’ Guides to the Medical Literature. A Manual for Evidence-Based Clinical Practice. Edited by Guyatt GH, Rennie D, Meade MO, Cook DJ. New York: McGraw Hill; 2008.
6.	Gruen RL, Morris PS, McDonald EL, et al. Making systematic reviews more useful for policy-makers. Bulletin of the World Health Organization, 2005, 83: 480-481.
7.	Lavis JN, Posada FB, Haines A, et al. Use of research to inform public policymaking. Lancet, 2004, 364: 1615-1621.
8.	Gilson L. The lessons of user fee experience in Africa. Health Policy Plan, 1997, 12: 273-285.
9.	Aaserud M, Dahlgren AT, Kosters JP, et al. Pharmaceutical policies: Effects of reference pricing, other pricing, and purchasing policies. Cochrane Database of Systematic Reviews, 2006, 2: CD005979.
10.	Vian T. Review of corruption in the health sector: Theory, methods and interventions. Health Policy and Planning, 2008, 23: 83-94.
11.	Devereaux PJ, Choi PT, Lacchetti C, et al. A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ, 2002, 166: 1399-1406.
12.	Gericke CA, Kurowski C, Ranson MK, et al. Intervention complexity: A conceptual framework to inform priority-setting in health. Bulletin of the World Health Organization, 2005, 83: 285-293.
13.	Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ, 2002, 324: 819-823.
14.	World Health Organization (WHO): Guidelines for the Treatment of Malaria. Geneva, World Health Organization. 2009.
15.	Lagarde M, Haines A, Palmer N. Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries: a systematic review. JAMA, 2007, 298: 1900-1910.
16.	Lewin SA, Dick J, Pond P, et al. Lay health workers in primary and community health care. Cochrane Database Syst Rev, 2005, 1: CD004015.
17.	Austvoll-Dahlgren A, Aaserud M, Vist G, et al. Pharmaceutical policies: effects of cap and co-payment on rational drug use. Cochrane Database Syst Rev, 2008, 1:CD007017.
18.	Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 11. Finding and using research evidence about local conditions. Health Res Policy Syst. In Press.
19.	Jamtvedt G, Young JM, Kristoffersen DT, et al. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev, 2006, 2: CD000259.
20.	Oxman AD, Fretheim A. An overview of research on the effects of results-based financing. Report Nr 16-2008. Oslo, Nasjonalt kunnskapssenter for helsetjenesten. 2008.
21.	Deeks JJ. Issues in the selection of a summary statistic for metaanalysis of clinical trials with binary outcomes. Statistics in Medicine, 2002, 21: 1575-1600.
22.	Engels EA, Schmid CH, Terrin N, et al. Heterogeneity and statistical significance in meta-analysis: An empirical study of 125 metaanalyses. Statistics in Medicine, 2000, 19: 1707-1728.
23.	Oxman AD, Lavis JN, Fretheim A, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 16. Using research evidence in balancing the pros and cons of policies. Health Res Policy Syst. In Press.
24.	Shepperd S, Iliffe S. Hospital at home versus in-patient hospital care. Cochrane Database of Systematic Reviews, 2005, 3: CD000356.
25.	Shepperd S, Doll H, Angus RM, et al. Admission avoidance hospital at home. Cochrane Database Syst Rev, 2008, 4: CD007491.
26.	Flottorp S. Do lay health workers in primary and community health care improve maternal and child health? A SUPPORT Summary of a systematic review. [http://www.iecs.org.ar/support/administracion/ files/20080909113811_13.pdf]. 2009.
27.	Lewin S, Munabi-Babigumira S, Bosch-Capblanch X, Aja G, van Wyk B, Glenton C, Scheel IB, Zwarenstein M, Daniels K: Lay health workers in primary and community health care: A systematic review of trials. A policy brief prepared for the International Dialogue on Evidence-Informed Action to Achieve Health Goals in Developing Countries (IDEAHealth). Geneva, World Health Organization. 2006.

1. Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst. In Press.
2. Lavis JN, Oxman AD, Grimshaw J, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 7. Finding systematic reviews. Health Res Policy Syst. In Press.
3. Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 8. Deciding how much confidence to place in a systematic review. Health Res Policy Syst. In Press.
4. Oxman AD, Lavis JN, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 10. Taking equity into consideration when assessing the findings of a systematic review. Health Res Policy Syst. In Press.
5. Dans AL, Dans LF, Guyatt GH. Applying results to individual patients. In Users’ Guides to the Medical Literature. A Manual for Evidence-Based Clinical Practice. Edited by Guyatt GH, Rennie D, Meade MO, Cook DJ. New York: McGraw Hill; 2008.
6. Gruen RL, Morris PS, McDonald EL, et al. Making systematic reviews more useful for policy-makers. Bulletin of the World Health Organization, 2005, 83: 480-481.
7. Lavis JN, Posada FB, Haines A, et al. Use of research to inform public policymaking. Lancet, 2004, 364: 1615-1621.
8. Gilson L. The lessons of user fee experience in Africa. Health Policy Plan, 1997, 12: 273-285.
9. Aaserud M, Dahlgren AT, Kosters JP, et al. Pharmaceutical policies: Effects of reference pricing, other pricing, and purchasing policies. Cochrane Database of Systematic Reviews, 2006, 2: CD005979.
10. Vian T. Review of corruption in the health sector: Theory, methods and interventions. Health Policy and Planning, 2008, 23: 83-94.
11. Devereaux PJ, Choi PT, Lacchetti C, et al. A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ, 2002, 166: 1399-1406.
12. Gericke CA, Kurowski C, Ranson MK, et al. Intervention complexity: A conceptual framework to inform priority-setting in health. Bulletin of the World Health Organization, 2005, 83: 285-293.
13. Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ, 2002, 324: 819-823.
14. World Health Organization (WHO): Guidelines for the Treatment of Malaria. Geneva, World Health Organization. 2009.
15. Lagarde M, Haines A, Palmer N. Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries: a systematic review. JAMA, 2007, 298: 1900-1910.
16. Lewin SA, Dick J, Pond P, et al. Lay health workers in primary and community health care. Cochrane Database Syst Rev, 2005, 1: CD004015.
17. Austvoll-Dahlgren A, Aaserud M, Vist G, et al. Pharmaceutical policies: effects of cap and co-payment on rational drug use. Cochrane Database Syst Rev, 2008, 1:CD007017.
18. Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 11. Finding and using research evidence about local conditions. Health Res Policy Syst. In Press.
19. Jamtvedt G, Young JM, Kristoffersen DT, et al. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev, 2006, 2: CD000259.
20. Oxman AD, Fretheim A. An overview of research on the effects of results-based financing. Report Nr 16-2008. Oslo, Nasjonalt kunnskapssenter for helsetjenesten. 2008.
21. Deeks JJ. Issues in the selection of a summary statistic for metaanalysis of clinical trials with binary outcomes. Statistics in Medicine, 2002, 21: 1575-1600.
22. Engels EA, Schmid CH, Terrin N, et al. Heterogeneity and statistical significance in meta-analysis: An empirical study of 125 metaanalyses. Statistics in Medicine, 2000, 19: 1707-1728.
23. Oxman AD, Lavis JN, Fretheim A, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 16. Using research evidence in balancing the pros and cons of policies. Health Res Policy Syst. In Press.
24. Shepperd S, Iliffe S. Hospital at home versus in-patient hospital care. Cochrane Database of Systematic Reviews, 2005, 3: CD000356.
25. Shepperd S, Doll H, Angus RM, et al. Admission avoidance hospital at home. Cochrane Database Syst Rev, 2008, 4: CD007491.
26. Flottorp S. Do lay health workers in primary and community health care improve maternal and child health? A SUPPORT Summary of a systematic review. [http://www.iecs.org.ar/support/administracion/ files/20080909113811_13.pdf]. 2009.
27. Lewin S, Munabi-Babigumira S, Bosch-Capblanch X, Aja G, van Wyk B, Glenton C, Scheel IB, Zwarenstein M, Daniels K: Lay health workers in primary and community health care: A systematic review of trials. A policy brief prepared for the International Dialogue on Evidence-Informed Action to Achieve Health Goals in Developing Countries (IDEAHealth). Geneva, World Health Organization. 2006.

《中國循證醫學雜志》

知證衛生決策工具之九——系統評價結果的適用性評價*

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《中國循證醫學雜志》

知證衛生決策工具之九——系統評價結果的適用性評價*

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