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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >The challenge - and promise - of local clinical practice guidelines
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The challenge - and promise - of local clinical practice guidelines

机译：本地临床实践指南面临的挑战-有望实现

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Clinical practice guidelines (CPGs) attempt to maximize the quality, efficiency, and cost-effectiveness of care delivered to patients by incorporating evidence-based recommendations into daily management. These can be developed on a national or professional society level, or they can be local endeavors. Resource availability, institutional culture, and local practice patterns can significantly impact local guideline development, resulting in marked heterogeneity between institutions. The article by Neuman et al in this issue of Pediatrics describes the variety of CPGs developed by freestanding children's hospitals for the diagnosis and treatment of community-acquired pneumonia (CAP) Participating hospitals used either no local CPG or had implemented various measures regarding diagnosis and management that, when compared between institutions, sometimes directly conflicted. The resulting analyses reflect the lack of impact one would expect with such variation. Only the most consistent recommendations-those that suggested specific antimicrobial regimens-demonstrated clinically significant differences between institutions that use or do not use CPGs. This is concerning, given that pediatricians, including trainees, use local CPGs more often than national guidelines for medical decision-making
机译：临床实践指南（CPG）试图通过将基于证据的建议纳入日常管理中，以最大程度地提高为患者提供的护理服务的质量，效率和成本效益。这些可以在国家或专业社会层面上进行开发，也可以是当地的努力。资源的可获得性，机构文化和当地实践模式会极大地影响当地指南的制定，从而导致机构之间明显的异质性。 Neuman等人在本期《儿科学》上的文章描述了独立儿童医院开发的各种CPG，用于诊断和治疗社区获得性肺炎（CAP）参与试验的医院没有使用本地CPG或已实施了各种有关诊断和管理的措施在机构之间进行比较时，有时会直接发生冲突。结果分析反映出人们对这种变化的预期缺乏影响。只有最一致的建议（那些建议使用特定的抗微生物药物的建议）才表明使用或不使用CPG的机构之间在临床上存在显着差异。令人担忧的是，包括受训人员在内的儿科医生使用国家CPG的频率高于国家医疗决策的准则

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