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首页> 美国卫生研究院文献>Canadian Medical Association Journal >Translating guidelines into practice: a systematic review of theoretic concepts practical experience and research evidence in the adoption of clinical practice guidelines
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Translating guidelines into practice: a systematic review of theoretic concepts practical experience and research evidence in the adoption of clinical practice guidelines

机译：将指南转化为实践：通过临床实践指南对理论概念实践经验和研究证据进行系统回顾

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OBJECTIVE: To recommend effective strategies for implementing clinical practice guidelines (CPGs). DATA SOURCES: The Research and Development Resource Base in Continuing Medical Education, maintained by the University of Toronto, was searched, as was MEDLINE from January 1990 to June 1996, inclusive, with the use of the MeSH heading "practice guidelines" and relevant text words. STUDY SELECTION: Studies of CPG implementation strategies and reviews of such studies were selected. Randomized controlled trials and trials that objectively measured physicians' performance or health care outcomes were emphasized. DATA EXTRACTION: Articles were reviewed to determine the effect of various factors on the adoption of guidelines. DATA SYNTHESIS: The articles showed that CPG dissemination or implementation processes have mixed results. Variables that affect the adoption of guidelines include qualities of the guidelines, characteristics of the health care professional, characteristics of the practice setting, incentives, regulation and patient factors. Specific strategies fell into 2 categories: primary strategies involving mailing or publication of the actual guidelines and secondary interventional strategies to reinforce the guidelines. The interventions were shown to be weak (didactic, traditional continuing medical education and mailings), moderately effective (audit and feedback, especially concurrent, targeted to specific providers and delivered by peers or opinion leaders) and relatively strong (reminder systems, academic detailing and multiple interventions). CONCLUSIONS: The evidence shows serious deficiencies in the adoption of CPGs in practice. Future implementation strategies must overcome this failure through an understanding of the forces and variables influencing practice and through the use of methods that are practice- and community-based rather than didactic.
机译：目的：为实施临床实践指南（CPG）推荐有效的策略。数据来源：使用MeSH标题“实践指南”和相关文本，搜索了由多伦多大学维护的持续医学教育研究与开发资源库，以及MEDLINE（包括1990年1月至1996年6月）。话。研究选择：选择CPG实施策略的研究和此类研究的综述。强调了随机对照试验和客观衡量医师绩效或医疗保健结果的试验。数据提取：对文章进行了审查，以确定各种因素对准则采用的影响。数据综合：文章表明，CPG的传播或实施过程产生了不同的结果。影响采用指南的变量包括指南的质量，医疗保健专业人员的特征，业务环境的特征，激励措施，法规和患者因素。具体策略分为两类：涉及邮寄或发布实际指南的主要策略和加强指南的辅助干预策略。干预措施被证明是薄弱的（指导性，传统的继续医学教育和邮寄），中等程度的有效（审计和反馈，尤其是同时进行的，针对特定提供者并由同行或意见领袖提供的）和相对较强的（提醒系统，学术细节和多种干预措施）。结论：证据表明在实践中采用CPG存在严重缺陷。未来的实施策略必须通过了解影响实践的力量和变量以及使用基于实践和社区而非方法的方法来克服这种失败。

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