中國能否應對指南挑戰？△_《中國循證醫學雜志》

作者：

1. 蘭州大學基礎醫學院循證醫學中心/GRADE中國中心（蘭州 730000）；2. 四川大學華西醫院中國Cochrane中心（成都 610041）；3. McMaster大學衛生科學中心臨床流行病學與醫學統計學系（加拿大安大略省漢密爾頓1280主大街西2C16室）;

關鍵詞：

DOI：

10.7507/1672-2531.20130108

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中國的衛生保健費用日益增加，但缺乏對衛生保健質量和經費支出的嚴格監控。基于現有最佳證據，以患者為中心的指南有助于提高衛生保健質量和促進從證據到實踐的轉化。本文闡述了指南如何推動中國醫療衛生體制改革（簡稱“醫改”），并特別總結了目前指南制定的現狀及相關挑戰，同時結合中國醫改大背景，對可能的解決方案進行了初步探索。中國目前尚缺乏由某個專門的權威機構來制定和傳播循證指南的能力。大多數指南使用者信賴專家小組制定的推薦意見，但這些推薦意見缺乏透明性（包括利益沖突的處理過程及證據檢索、評價與合成過程的透明性），質量也無法保證。此外，人們對指南的作用存在認識誤區，認為指南的作用只是為臨床工作者提供決策信息而非必須遵守的準則；另外也有觀點認為無法制定傳統中醫藥的循證指南。所以，如果能夠建立一個為指南制定提供或整合所有證據、指導指南制定工作及評價指南的核心機構，并與國際相關組織合作，不僅可以加強中國循證指南的制定能力，而且能夠應對循證指南制定面臨的挑戰。

引用本文： 楊克虎,陳耀龍,李幼平,Holger J Schnemann,代表蘭州國際臨床實踐指南研討會成員. 中國能否應對指南挑戰？△. 中國循證醫學雜志, 2013, 13(6): 621-623. doi: 10.7507/1672-2531.20130108 復制

1.	Meng Q, Xu L, Zhang Y, et al. Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study. Lancet, 2012, 379: 805-814.
2.	Yip WC-M, Hsiao WC, Chen W, et al. Early appraisal of China’s huge and complex health-care reforms. Lancet, 2012, 379: 833-842.
3.	Lumbiganon P, Laopaiboon M, Gulmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007 – 08. Lancet, 2010, 375: 490- 499.
4.	Global Programme on Evidence for Health Policy: Guidelines for WHO guidelines. EIP/GPE/EQC/2003.1. Geneva: World Health Organization; 2003.
5.	Oxman AD, Fretheim A, Schunemann HJ. Improving the use of research evidence in guideline development: introduction. Health Res Policy Syst, 2006, 4: 12.
6.	IOM (Institute-of-Medicine). Clinical practice guidelines We Can trust. Washington, DC: The National Academies Press; 2011.
7.	Schunemann HJ, Woodhead M, Anzueto A, et al. A guide for guidelines for professional societies and other developers of recommendations: an official American Thoracic society (ATS)/European Respiratory Society (ERS) Workshop Report. Proc Am Thorac Soc, in press.
8.	Alonso-Coello P, Irfan A, Sola I, et al. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care, 2010, 19: e58.
9.	Chen YL, Yao L, Xiao XJ, et al. Quality assessment of clinical guidelines in China: 1993 – 2010. Chin Med J, 2012, 125(20): 3660-3664.
10.	Peking University Health Science Center: http://www.nhei.cn/export/sites/nhei/ennheis/wn/news/news_0009.html.
11.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336: 924–926.
12.	Schunemann HJ, Woodhead M, Anzueto A, et al. A vision statement on guideline development for respiratory disease: the example of COPD. Lancet, 2009, 373: 774-779.
13.	AGREE Next Steps Consortium (2009): The AGREE II Instrument [Electronic version] AJ; 2012. at http://www.agreetrust.org.

1. Meng Q, Xu L, Zhang Y, et al. Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study. Lancet, 2012, 379: 805-814.
2. Yip WC-M, Hsiao WC, Chen W, et al. Early appraisal of China’s huge and complex health-care reforms. Lancet, 2012, 379: 833-842.
3. Lumbiganon P, Laopaiboon M, Gulmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007 – 08. Lancet, 2010, 375: 490- 499.
4. Global Programme on Evidence for Health Policy: Guidelines for WHO guidelines. EIP/GPE/EQC/2003.1. Geneva: World Health Organization; 2003.
5. Oxman AD, Fretheim A, Schunemann HJ. Improving the use of research evidence in guideline development: introduction. Health Res Policy Syst, 2006, 4: 12.
6. IOM (Institute-of-Medicine). Clinical practice guidelines We Can trust. Washington, DC: The National Academies Press; 2011.
7. Schunemann HJ, Woodhead M, Anzueto A, et al. A guide for guidelines for professional societies and other developers of recommendations: an official American Thoracic society (ATS)/European Respiratory Society (ERS) Workshop Report. Proc Am Thorac Soc, in press.
8. Alonso-Coello P, Irfan A, Sola I, et al. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care, 2010, 19: e58.
9. Chen YL, Yao L, Xiao XJ, et al. Quality assessment of clinical guidelines in China: 1993 – 2010. Chin Med J, 2012, 125(20): 3660-3664.
10. Peking University Health Science Center: http://www.nhei.cn/export/sites/nhei/ennheis/wn/news/news_0009.html.
11. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336: 924–926.
12. Schunemann HJ, Woodhead M, Anzueto A, et al. A vision statement on guideline development for respiratory disease: the example of COPD. Lancet, 2009, 373: 774-779.
13. AGREE Next Steps Consortium (2009): The AGREE II Instrument [Electronic version] AJ; 2012. at http://www.agreetrust.org.

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