衛生決策中對系統評價的十大認識誤區_《中國循證醫學雜志》

作者：

 童峰 , 拜爭剛

1. 西南財經大學（成都 610000）；2. 蘭州大學循證醫學中心（蘭州 730000）;

關鍵詞：

循證醫學系統評價決策依據衛生決策循證實踐

DOI：

10.7507/1672-2531.20130094

視頻：

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隨著循證實踐的蓬勃開展，系統評價證據越來越被視為決策的可靠依據，特別是在時間緊急，任務重要，且干擾因素多的情況下，其優勢更為凸顯。但在非醫學領域中，對循證實踐及系統評價作用的認知還存在一定局限性，許多認識誤區阻礙了系統評價方法在衛生決策領域的推廣與使用。本文以健康干預實踐證據為例，探討系統評價在衛生決策領域的作用，力圖澄清這些認識誤區，推動系統評價的發展。

引用本文： 童峰,拜爭剛. 衛生決策中對系統評價的十大認識誤區. 中國循證醫學雜志, 2013, 13(5): 531-535. doi: 10.7507/1672-2531.20130094 復制

1.	Trinder L, Reynolds S. Evidence-based Practice: A Critical Appraisal. Oxford: Blackwell Science, 2000: 17.
2.	Walshe K, Rundall TG. Evidence-based management: From theory to practice in health care. Milbank Quarterly, 2001, 73: 429-457, IV-V.
3.	Petticrew M. Systematic reviews from astronomy to zoology: myths and misconceptions. BMJ (Clinical research ed.), 2001, 322: 98-101.
4.	Mays N, Pope C, Popay J. Systematic reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. Journal of Health Services Research Policy, 2005, 10(suppl_1): 6-20.
5.	Lavis JN, Davies HT, Gruen RL, et al. Working within and beyond the Cochrane Collaboration to make systematic reviews more useful to healthcare managers and policy makers. Healthcare Policy, 2006, 1: 21-33.
6.	Lavis JN. How can we support the use of systematic reviews in policymaking? PLOS Medicine, 2009, 6: e1000141.
7.	Lavis J, Oxman A, Grimshaw J, et al. SUPPORT Tools for evidence-informed health Policymaking (STP) 7: Finding systematic reviews. Health research policy and systems Central [serial online], 2009 [cited 2011 Jun 10]; 7 Suppl 1: S7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20018114.
8.	Devereaux PJ, Choi PTL, 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. Canadian Medical Association Journal, 2002, 166: 1399-1406.
9.	Commission on the Future of Health Care in Canada. Building on Values: The Future of Health Care in Canada. Ottawa, Canada: 2002.
10.	Lavis JN, Panisset U. EVIPNet Africa’s first series of policy briefs to support evidence-informed policymaking. International Journal of Technology Assessment in Health Care, 2010, 26: 229-232.
11.	Hayes SL, Mann MK, Morgan FM, et al. Collaboration between local health and local government agencies for health improvement. Cochrane Database of Systematic Reviews 2011, 6: CD007825. DOI: 10.1002/14651858.CD007825.
12.	Gosden T, Forland F, Kristiansen IS, et al. Capitation, salary, fee-for-service and mixed systems of payment: Effects on the behavior of primary care physicians. Cochrane Database of Systematic Reviews, 2000, 3: CD002215. DOI: 10.1002/14651858.CD002215.
13.	Lewis R, Neal RD, Williams NH, et al. Nurse-led vs. conventional physician-led follow-up for patients with cancer: Systematic review. Journal of Advanced Nursing, 2009, 65: 706-723.
14.	Moat KA, Lavis JN, Wilson MG, et al. Twelve myths about systematic reviews for health system policymaking rebutted. J Health Servers Policy, 2013, 18(1): 44-50.
15.	Albada A, Ausems MG, Bensing JM, et al. Tailored information about cancer risk and screening: A systematic review. Patient Education and Counseling, 2009, 77: 155-171.
16.	呂筠, 李立明. 循證公共政策與公共衛生改革路徑. 人文雜志, 2006, (1): 146-151.
17.	Roberts MJ, Hsiao W, Berman P, et al. Getting Health Reform Right: A Guide to Improving Performance and Equity. Oxford, UK: Oxford University Press, 2004.
18.	陳慶升. 救助管理政策反思——以證據為本與社會政策. 中外企業家, 2006, (10): 82-85.
19.	Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ, 2007, 85(10): 812-819.
20.	Gravolin M, Rowell K, De Groot J. Interventions to support the decision-making process for older people facing the possibility of long-term residential care. The Cochrane Collaboration, 8 OCT 2008.
21.	Paul M, Evan MW, Jane AD. Personal assistance for older adults (65+) without dementia. The Cochrane Collaboration, 21 JAN 2009.
22.	Rockers PC, Feigl A, Rottingen RA, et al. Study-design selection criteria in systematic reviews of effectiveness of health systems interventions and reforms: A meta-review, 2006.
23.	曾憲濤, 冷衛東, 李勝, 等. 如何正確理解及使用GRADE系統. 中國循證醫學雜志 2011, 11(9): 985-990.
24.	Grimshaw J, Wilson B, Campbell M, et al. Epidemiological Methods, In: Fulop N, editor. Studying the Organisation and Delivery of Health Services: Research Methods, New York: Routledge, 2001.
25.	熊俊, 陳日新. 系統評價/Meta分析方法學質量的評價工具AMSTAR. 中國循證醫學雜志, 2011, 11(9): 1084-1089.
26.	Shea B, Grimshaw J, Wells G, et al. Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology [serial online], 2007[cited 2008 Jun 1];7: 10.Available from: http://www.biomedcentral.com/1471-2288/7/10.
27.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research Ed.), 2008, 336: 924-926.
28.	Gruen R, Weeramanthri TS, Knight SE, et al. Specialist outreach clinics in primary care and rural hospital settings. Cochrane Database of Systematic Reviews, 2003, 4: CD003798. DOI: 10.1002/14651858.CD003798.
29.	Flottorp S. Do specialist outreach visits in primary care and rural hosptial settings improve care. A SUPPORT Summary of a systematic review, 2008. [Serial online], 2008[cited 2009 Jun 25], 7(1): [24 screen]. Available http //www.supportcollaboration.org/summaries.htm.
30.	Wiysonge CS, Okwundu CI. Does midwife-led care improve the delivery of care to women during and after pregnancy. A SUPPORT Summary of a systematic review, 2009[serial online] 2009 [cited 2010 Jun 15], 5(2). Available from: www.support-collaboration.org/summaries.htm.
31.	Grobler LA, Marais BJ, Mabunda SA, et al. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database of Systematic Reviews, 2009;2: CD005314. DOI: 10.1002/14651858.CD005314.
32.	Ba¨rnighausen T, Bloom D. Financial incentives for return of service in underserved areas: A systematic review. BMC Health Services Research, 2009, 29: 86.
33.	World Health Organization. Increasing access to health workers in remote and rural areas through improved retention. Geneva: World Health Organization, 2010.
34.	Lavis JN, Davies HTO, Oxman A, et al. Towards systematic reviews that inform health care management and policy-making. Journal of Health Services Research Policy, 10(suppl_1): 35-48.
35.	Bateganya MH, Abdulwadud OA, Kiene SM. Home-based HIV voluntary counseling and testing in developing countries. Cochrane Database of Systematic Reviews, 2007; 4: CD006493. DOI: 10.1002/14651858.CD006493.
36.	Hopkins H, Talisuna A, Whitty CJ, et al. Impact of home-based management of malaria on health outcomes in Africa: A systematic review of the evidence. Malaria Journal, 2007, 6: 134.
37.	Lavis JN, Oxman A, Souza N, et al. SUPPORT Tools for evidence-informed health Policymaking (STP) 9: Assessing the applicability of the findings of a systematic review. Health Research Policy and Systems, 7(Suppl 1): S9.
38.	Sturm H, Austvol DA, Aaserud M, et al. Pharmaceutical policies: Effects of financial. Cochrane Database of Systematic Reviews, 2007; 3: CD006731. DOI: 10.1002/14651858.CD006731.
39.	曾憲濤, 李勝, 馬鉆, 等. Meta分析系列之八: Meta分析的報告規范. 中國循證心血管醫學雜志, 2012, 4(6): 500-503.
40.	楊智榮, 詹思延. PROSPERO: 為非Cochrane系統評價全新打造的注冊平臺. 中華醫學雜志, 2012, 92(6): 422-425.
41.	Sheldon TA. Making evidence synthesis more useful for management and policy-making. Journal of Health Services Research Policy, 10 Suppl 1: 1-5.
42.	Misso M, Green S, Brennan S, et al. Policy relevant summaries: Encouraging and supporting Australian policymakers to use Cochrane reviews. In: XV Cochrane Colloquium, Sao Paolo, Brazil: October, 2007: 23-27.

1. Trinder L, Reynolds S. Evidence-based Practice: A Critical Appraisal. Oxford: Blackwell Science, 2000: 17.
2. Walshe K, Rundall TG. Evidence-based management: From theory to practice in health care. Milbank Quarterly, 2001, 73: 429-457, IV-V.
3. Petticrew M. Systematic reviews from astronomy to zoology: myths and misconceptions. BMJ (Clinical research ed.), 2001, 322: 98-101.
4. Mays N, Pope C, Popay J. Systematic reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. Journal of Health Services Research Policy, 2005, 10(suppl_1): 6-20.
5. Lavis JN, Davies HT, Gruen RL, et al. Working within and beyond the Cochrane Collaboration to make systematic reviews more useful to healthcare managers and policy makers. Healthcare Policy, 2006, 1: 21-33.
6. Lavis JN. How can we support the use of systematic reviews in policymaking? PLOS Medicine, 2009, 6: e1000141.
7. Lavis J, Oxman A, Grimshaw J, et al. SUPPORT Tools for evidence-informed health Policymaking (STP) 7: Finding systematic reviews. Health research policy and systems Central [serial online], 2009 [cited 2011 Jun 10]; 7 Suppl 1: S7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20018114.
8. Devereaux PJ, Choi PTL, 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. Canadian Medical Association Journal, 2002, 166: 1399-1406.
9. Commission on the Future of Health Care in Canada. Building on Values: The Future of Health Care in Canada. Ottawa, Canada: 2002.
10. Lavis JN, Panisset U. EVIPNet Africa’s first series of policy briefs to support evidence-informed policymaking. International Journal of Technology Assessment in Health Care, 2010, 26: 229-232.
11. Hayes SL, Mann MK, Morgan FM, et al. Collaboration between local health and local government agencies for health improvement. Cochrane Database of Systematic Reviews 2011, 6: CD007825. DOI: 10.1002/14651858.CD007825.
12. Gosden T, Forland F, Kristiansen IS, et al. Capitation, salary, fee-for-service and mixed systems of payment: Effects on the behavior of primary care physicians. Cochrane Database of Systematic Reviews, 2000, 3: CD002215. DOI: 10.1002/14651858.CD002215.
13. Lewis R, Neal RD, Williams NH, et al. Nurse-led vs. conventional physician-led follow-up for patients with cancer: Systematic review. Journal of Advanced Nursing, 2009, 65: 706-723.
14. Moat KA, Lavis JN, Wilson MG, et al. Twelve myths about systematic reviews for health system policymaking rebutted. J Health Servers Policy, 2013, 18(1): 44-50.
15. Albada A, Ausems MG, Bensing JM, et al. Tailored information about cancer risk and screening: A systematic review. Patient Education and Counseling, 2009, 77: 155-171.
16. 呂筠, 李立明. 循證公共政策與公共衛生改革路徑. 人文雜志, 2006, (1): 146-151.
17. Roberts MJ, Hsiao W, Berman P, et al. Getting Health Reform Right: A Guide to Improving Performance and Equity. Oxford, UK: Oxford University Press, 2004.
18. 陳慶升. 救助管理政策反思——以證據為本與社會政策. 中外企業家, 2006, (10): 82-85.
19. Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ, 2007, 85(10): 812-819.
20. Gravolin M, Rowell K, De Groot J. Interventions to support the decision-making process for older people facing the possibility of long-term residential care. The Cochrane Collaboration, 8 OCT 2008.
21. Paul M, Evan MW, Jane AD. Personal assistance for older adults (65+) without dementia. The Cochrane Collaboration, 21 JAN 2009.
22. Rockers PC, Feigl A, Rottingen RA, et al. Study-design selection criteria in systematic reviews of effectiveness of health systems interventions and reforms: A meta-review, 2006.
23. 曾憲濤, 冷衛東, 李勝, 等. 如何正確理解及使用GRADE系統. 中國循證醫學雜志 2011, 11(9): 985-990.
24. Grimshaw J, Wilson B, Campbell M, et al. Epidemiological Methods, In: Fulop N, editor. Studying the Organisation and Delivery of Health Services: Research Methods, New York: Routledge, 2001.
25. 熊俊, 陳日新. 系統評價/Meta分析方法學質量的評價工具AMSTAR. 中國循證醫學雜志, 2011, 11(9): 1084-1089.
26. Shea B, Grimshaw J, Wells G, et al. Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology [serial online], 2007[cited 2008 Jun 1];7: 10.Available from: http://www.biomedcentral.com/1471-2288/7/10.
27. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research Ed.), 2008, 336: 924-926.
28. Gruen R, Weeramanthri TS, Knight SE, et al. Specialist outreach clinics in primary care and rural hospital settings. Cochrane Database of Systematic Reviews, 2003, 4: CD003798. DOI: 10.1002/14651858.CD003798.
29. Flottorp S. Do specialist outreach visits in primary care and rural hosptial settings improve care. A SUPPORT Summary of a systematic review, 2008. [Serial online], 2008[cited 2009 Jun 25], 7(1): [24 screen]. Available http //www.supportcollaboration.org/summaries.htm.
30. Wiysonge CS, Okwundu CI. Does midwife-led care improve the delivery of care to women during and after pregnancy. A SUPPORT Summary of a systematic review, 2009[serial online] 2009 [cited 2010 Jun 15], 5(2). Available from: www.support-collaboration.org/summaries.htm.
31. Grobler LA, Marais BJ, Mabunda SA, et al. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database of Systematic Reviews, 2009;2: CD005314. DOI: 10.1002/14651858.CD005314.
32. Ba¨rnighausen T, Bloom D. Financial incentives for return of service in underserved areas: A systematic review. BMC Health Services Research, 2009, 29: 86.
33. World Health Organization. Increasing access to health workers in remote and rural areas through improved retention. Geneva: World Health Organization, 2010.
34. Lavis JN, Davies HTO, Oxman A, et al. Towards systematic reviews that inform health care management and policy-making. Journal of Health Services Research Policy, 10(suppl_1): 35-48.
35. Bateganya MH, Abdulwadud OA, Kiene SM. Home-based HIV voluntary counseling and testing in developing countries. Cochrane Database of Systematic Reviews, 2007; 4: CD006493. DOI: 10.1002/14651858.CD006493.
36. Hopkins H, Talisuna A, Whitty CJ, et al. Impact of home-based management of malaria on health outcomes in Africa: A systematic review of the evidence. Malaria Journal, 2007, 6: 134.
37. Lavis JN, Oxman A, Souza N, et al. SUPPORT Tools for evidence-informed health Policymaking (STP) 9: Assessing the applicability of the findings of a systematic review. Health Research Policy and Systems, 7(Suppl 1): S9.
38. Sturm H, Austvol DA, Aaserud M, et al. Pharmaceutical policies: Effects of financial. Cochrane Database of Systematic Reviews, 2007; 3: CD006731. DOI: 10.1002/14651858.CD006731.
39. 曾憲濤, 李勝, 馬鉆, 等. Meta分析系列之八: Meta分析的報告規范. 中國循證心血管醫學雜志, 2012, 4(6): 500-503.
40. 楊智榮, 詹思延. PROSPERO: 為非Cochrane系統評價全新打造的注冊平臺. 中華醫學雜志, 2012, 92(6): 422-425.
41. Sheldon TA. Making evidence synthesis more useful for management and policy-making. Journal of Health Services Research Policy, 10 Suppl 1: 1-5.
42. Misso M, Green S, Brennan S, et al. Policy relevant summaries: Encouraging and supporting Australian policymakers to use Cochrane reviews. In: XV Cochrane Colloquium, Sao Paolo, Brazil: October, 2007: 23-27.

《中國循證醫學雜志》

衛生決策中對系統評價的十大認識誤區

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《中國循證醫學雜志》

衛生決策中對系統評價的十大認識誤區

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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