This article elaborates the concept, meaning and role of clinical pathway, discusses development stages and implementation effects of clinical pathway at home and abroad, and proposes that clinical pathway has been developed very well abroad, but it still has many problems in domestic gtowth which needs to be put into effect with Single-DRGs system in combination.
N-of-1 trial design offers a methodologically sound approach to determining optimum treatment for an individual patient and solves some limitations of randomized controlled trials. This design could offer an efficient method of reaching a personal treatment regime tailored to suit individual needs and preferences. The paper introduces practical application, objects and the implementation process of N-of-1 trial, to explore its design points and implementation.
ObjectiveTo evaluate the reliability and validity of Guideline Implementation Success Assessment Tool (A-GIST). MethodsWith the guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition) as the target guideline, health care providers and patients from different hospitals across the country were investigated by questionnaire using A-GIST. Spearman-Brown coefficient and Cronbach's α coefficient were used to evaluate the split-half reliability and internal consistency reliability, while the structural validity, convergent validity and discriminant validity were investigated by confirmatory factor analysis based on structural equation. ResultsThe internal consistency reliability and split half reliability coefficients of the whole tool and each dimension ranged from 0.650 to 0.986. The scale-level content validity index (S-CVI/Ave) of content validity was 0.846. Confirmatory factor analysis showed that, the χ2/df of two sections of the tool were 8.695 and 6.123, respectively. The root mean square residual (RMR), the standard root mean square residual (SRMR) and the root mean square error of approximation (RMSEA) were under or almost under the threshold. Besides, the goodness-of-fit index (GFI) of them were 0.901 and 0.822, the adjusted goodness-of-fit index (AGFI) were 0.836 and 0.787, and the parsimonious normed fit index (PNFI) were 0.545 and 0.788, respectively. ConclusionGuideline Implementation Success Assessment Tool (A-GIST) was proved to be valid and reliable, and it shows that it is necessary to optimize the items under the dimensions of maintenance and evaluation of diagnosis and treatment effect in the future.
Objective The ultimate goal of developing guidelines is for using them in clinical practice. In this study, an implementation evaluation tool was developed to promote the overall evaluation of guidelines and to improve their promotion and implementation. Methods The research group set up a team to formulate and establish a guideline implementation evaluation tool, through preliminary research, interviews, a systematic review of relevant literature, two expert consensus meetings and two Delphi expert consensus meetings to evaluate the guideline implementation tool. Experts were invited to give opinions and grades on the fields, items and overall implementation evaluation method of the tool. Results The evaluation tool for the implementation of guidelines included 5 fields, accessibility, communicability, performability, recognizability and applicability, with a total of 7 items. The scale-level CVIs in two rounds of Delphi expert consensus were 0.91 and 0.93. We collected opinions and suggestions and made some revisions and insertions without deleting any items based on the parameter that no items fulfilled the standard if mean <3.5, coefficient of variation >15% and I-CVI<0.78. Conclusion In this study, in order to provide a standard and method for the evaluation of guideline implementation, a guideline implementation evaluation tool has been developed and evaluated by clinically-related physicians and guideline formulation methodology experts. The guideline implementation evaluation tool presents satisfactory face and content validity. Empirical research is needed to verify the tool’s performance in evaluating guideline implementation.
Evidence-based evidence translated into health care services requires three conversion processes, preclinical research-clinical research-implementation research, which might take a very long time. In order to speed up the process of research results translated into daily medical practice and health policy, an effectiveness-implementation hybrid design combining the effectiveness research of clinical and implementation research was emerging. This paper introduced the concept, classification and application of effectiveness-implementation hybrid design, to provide references for researchers in this area.
Currently, there is a lack of clarity and standardization regarding the implementation details of interventions in traditional Chinese medicine clinical practice guidelines (CPGs). This in methodological guidance for standardizing the implementation prescription adversely impacts the quality of implementation and hinders the clinical application rate of recommendations. Through in-depth analysis of implementation prescription of evidence-based CPGs in traditional Chinese medicine, we identified the challenges associated with standardization. In response, we propose enhancing the technical specifications of implementation prescriptions, advocating for improved formulation processes, diverse reporting approaches, and standardizedological guidelines. These recommendations aim to serve as a methodological reference and guidance for clinical practice guideline developers.
ObjectiveTo evaluate the implementability of traditional Chinese medicine (TCM) guidelines in the field of paediatrics. MethodsWe searched the paediatrics-related TCM guidelines published in CNKI, WanFang Data, VIP, SinoMed and PubMed databases, and related websites from inception to November 1, 2023. The implementability of the included guidelines was evaluated using the clinical practice guideline implementability assessment tool. ResultsA total of 47 guidelines were included, covering 37 paediatric diseases and recommending 27 TCM therapies, including TCM decoction, Chinese patent medicines, acupuncture, paediatric massage, and acupoints. The results of the guideline implementability evaluation showed that 5 guidelines (10.6%) were of high grade, 12 guidelines (25.5%) were of medium grade, and 30 guidelines (63.8%) were of low grade. With the exception of accessibility (multi-channel access methods) and communicability, which was of high quality, there is room for improvement in all areas, particularly in the areas of applicability and ease of recognition. ConclusionThe overall quality of implementability of the included paediatric TCM guidelines was low, and it is recommended that in the process of developing paediatric TCM guidelines in the future, we focus on improving the quality of implementability of the guidelines themselves from the source, so as to promote the implementation and application of the guidelines.
The consolidated framework for implementation research (CFIR) extracted, analyzed and integrated many published theories, frameworks and models of implementation research, and provided a comprehensive and practical theoretical framework for researchers to explore the influencing factors in the implementation of evidence. This paper introduces the origin, core content and application examples of CFIR in evidence-based nursing practice, in order to provide reference for researchers to use CFIR to carry out implementation research.
ObjectiveTo analyze the problems in the construction of internal control in colleges and universities, and to explore the implementation path suitable for colleges and universities. MethodsThe relevant documents on the internal control construction of universities at home and abroad were retrieved, and the case study of the implementation path of the internal control system construction of C university was analyzed by using the methods of expert interviews, flow charts and walk-through tests. ResultsThe internal control system of colleges and universities takes digital intelligence as the technical support to explore the implementation path of "external standard rule riveting point, internal standard post entry process; data standardization, process progress visualization; speed of operation tracking, data backtracking to find deviation; business data is all smooth, performance evaluation to promote management", optimize the process and improve the system, real-time extraction of operation data for key projects to track, and shorten the business operation time by more than half. ConclusionThe case university carries out empirical research on the internal control system, based on the principle of effective implementation, makes full use of the digital intelligence technology to extract the whole process data of the business system across the system, and realizes the efficient collaboration, early warning and evaluation, and scientific decision-making of the "digital intelligence" platform.
Objective To review main obstacles to health care professionals' adherence to clinical practice guidelines (CPGs) by employing the scoping review method and a determinants framework, and to explore the effect of implementation strategies in intervention researches on guideline adherence. Methods The articles published from January 1, 2011 to June 10, 2023 were retrieved from the PubMed, CINAHL, MEDLINE, Embase, Scopus, Cochrane Library, SinoMed, CNKI, WanFang Data and VIP databases. The original literature on the CPGs implementation obstacles and strategies was included, and the primary and secondary screening of the literature were completed by four researchers according to the inclusion and exclusion criteria. The basic characteristics of the literature, the factors affecting the implementation of the CPGs, and the strategies used were extracted. The results were analyzed and summarized using qualitative and quantitative methods. Results A total of 61 articles were included in the scoping review. The factors affecting the implementation of CPGs could be divided into five categories: guidelines themselves, external factors, internal factors, individual factors, and implementation process. The most common implementation obstacles were insufficient knowledge or skills of professionals regarding guidelines (n=21, 34.4%), insufficient necessity of using guidelines according to doctors (n=17, 27.9%), and unreasonable factors within hospital (n=16, 26.2%). The factors that promoted the implementation of CPGs included guidelines based on high-quality evidence (n=5, 8.2%), good department or hospital culture (n=4, 6.6%), convenient accessibility of guideline knowledge and information (n=4, 6.6%), and doctors’ excellent professional ability (n=4, 6.6%). The overall effectiveness of the guideline implementation strategy was 50%. Clinical decision support system (CDSS) could improve the adherence of CPGs. Guideline education or training was one of the most commonly used methods, but the effect of improving guideline compliance was unstable. Conclusion The primary challenges in implementing guidelines include inadequate professional capacity and demand, suboptimal hospital infrastructure and limited resources. However, the obstacles are not absolute. It is recommended to use implementation strategies to improve the absorption and implementation of guidelines, among which CDSS is an effective measure for promoting guideline adherence.