scholarly journals Analysis of the Status and Trends of Chinese Clinical Practice Guideline Development Between 2010 and 2020: A Systematic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Rong Zhang ◽  
Si-yu Yan ◽  
Yun-yun Wang ◽  
Qiao Huang ◽  
Xiang-ying Ren ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Methodological Quality ◽  
Evidence Based ◽  
Healthcare Decision ◽  
Inclusion Criteria ◽  
Healthcare Decision Making ◽  
Status And Trends ◽  
The Status

Objective: This study aimed to systematically review the status and trends of Chinese clinical practice guidelines (CPGs) during the time period 2010–2020 and explore their methodological characteristics. Then, based on the strengths and weaknesses in development, offer several recommendations for the quality improvement which will serve as a reference for the users and developers of CPG.Introduction: With the development of evidence-based medicine (EBM), the CPGs play an increasingly important role in healthcare decision-making both in China and worldwide.Inclusion criteria: The CPGs that have been used to help the health professionals in the healthcare decision-making were included.Methodology: The China National Knowledge Infrastructure (CNKI) and WanFang databases were searched from 2010 to 2020 for the studies describing the general and methodological characteristics of Chinese CPGs. Comparisons of the methodological characteristics between the groups were conducted using the chi-square test or Fisher's exact test. The M-K test was adopted to identify the monotonically increasing or decreasing trends of methodological characteristics over the timespan.Results: A total of 2,654 CPGs fulfilled the inclusion criteria. The quantity and quality of the guidelines developed in China have improved over the time span. From 2010 to 2020,the guidelines had differing characteristics and covered a wide range of subjects. In total, 2,318(87.34%) guidelines focused on Western Medicine. Eight (0.30%) had been developed for patient versions of guidelines, 10(0.38%) were tentative guidelines, and 16(0.60%) were rapid advice guidelines. Medical specialty societies (including their branches) (71.1%) were the main guideline makers. The most addressed diseases were neoplasms (14.43%). The target population is mainly adults (84.97%). The methodological quality of consensus-based (CB)-CPGs was obviously lower than evidence-based (EB)-CPGs. Except for the item, “recommendations were based on evidence of systematic reviews,” there were statistical differences in all other methodological items between the EB-CPGS and CB-CPGS (P < 0.01). Higher methodological quality has been observed in EB-CPGs. All the data relating to the methodological characteristics indicated that higher methodological quality was present in the guidelines using GRADE (P < 0.01).Conclusion: The quantity and quality of the guidelines developed in China have improved between 2010 and 2020. CB-CPGs have also paid attention to the methodology quality, but obviously, this is lower than that in the EB-CPGs.

scholarly journals VALUE AND APPLICABILITY OF LARGE ADMINISTRATIVE HEALTHCARE DATABASES IN PROSTHETICS AND ORTHOTICS OUTCOMES RESEARCH

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Taavy Miller ◽  
Shane Wurdeman
Keyword(s):  
Decision Making ◽  
Data Analysis ◽  
Health Economics ◽  
Clinical Data ◽  
Outcomes Research ◽  
Healthcare Decision ◽  
Healthcare Data ◽  
Healthcare Decision Making

The goal of health economics and outcomes research is to improve healthcare decision making. In the absence of high-value clinical data, the availability and quality of administrative healthcare data could be vital in the generation of evidence for orthotics and prosthetics services. The purpose of this article is to provide a stronger understanding of administrative healthcare data analysis, an area that has been scarcely examined within prosthetics and orthotics despite the wealth of information available within such data. Examples of common datasets in this arena currently available are provided, as well as an overview of the limitations and advantages of studies utilizing such datasets. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35958/28315 How To Cite: Miller TA, Wurdeman S. Value and applicability of large administrative healthcare databases in prosthetics and orthotics outcomes research. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.4. https://doi.org/10.33137/cpoj.v4i2.35958 Corresponding Author: Taavy A Miller, PhD, CPODepartment of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas, USA.E-Mail: [email protected] ID: https://orcid.org/0000-0001-7117-6124

Measuring outcomes and monitoring progress in the era of evidence-based clinical practice

2019 ◽  
Vol 20 (3) ◽  
pp. 276-288
Author(s):  
Robyn L. Tate
Keyword(s):  
Clinical Practice ◽  
Outcome Measurement ◽  
Presidential Address ◽  
Assessment Instruments ◽  
Scientific Quality ◽  
Evidence Based ◽  
Behavioural Assessment ◽  
The Status ◽  
Measuring Outcomes

AbstractHealth outcome measurement is a growth industry. Thousands of behavioural assessment instruments, developed for neurological populations alone, are available for diagnosis, prediction and evaluation of interventions. The task of selecting the best instrument for the purpose at hand is thus a daunting one for the clinician and researcher. Fortunately, there are guides that make the task easier. This presidential address covers three interrelated themes that inform assessment in neurorehabilitation: First, it reviews current concepts and the status of behavioural assessment in neurorehabilitation. It then examines evidence-based clinical practice as applied to assessment of function, along with methods to benchmark the scientific quality of assessment instruments. Finally, the article considers the need to move beyond outcome measurement in the neurorehabilitation setting.

PP554 Quality Assessment Of Clinical Practice Guidelines On Chronic Obstructive Pulmonary Disease Based On The Appraisal Of Guidelines For Research And Evaluation II (AGREE II) Instrument

2020 ◽  
Vol 36 (S1) ◽  
pp. 42-42
Author(s):  
Qian Xu ◽  
Kun Zhao ◽  
Cheng A Xin Duan ◽  
Dandan Ai ◽  
Binyan Sui
Keyword(s):  
Clinical Practice ◽  
Practice Guidelines ◽  
Chronic Obstructive ◽  
Evidence Based ◽  
Inclusion Criteria ◽  
Agree Ii ◽  
Obstructive Pulmonary Disease ◽  
Evidence Based Guidelines ◽  
Agree Ii Instrument

IntroductionThe scientific application of clinical evidence-based guidelines can reduce the variability of clinical practice, and standardize clinical diagnosis and treatment pathways. At present, many evidence-based guidelines on Chronic Obstructive Pulmonary Disease (COPD) prevention have been issued in countries around the world, but the procedures and evaluation strategies developed by different guidelines are not the same. This study aimed to evaluate the quality of published clinical practice guidelines (CPGs) relating to COPD using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.MethodsDatabases were systematically searched PubMed, EMBASE, Wan Fang, and CNKI as well as guidelines websites on COPD prevention and treatment. The search period was from inception of the database up to May 2019. The inclusion criteria for this study are as follows: (i) published and in accordance with the definition of the practice guidelines; (ii)the main target population is COPD patients with the diagnostic criteria of the 2019 edition of the global initiative for COPD (GOLD), and the content of the guideline is related to the prevention and treatment practice of COPD; (ii) the same guide is included in the latest updated version; (iv) the published language is English or Chinese. Guidelines that met these inclusion criteria were evaluated for the quality of the AGREE II guidelines. Then, a descriptive analysis was made of the consensus that exists in the guidelines.ResultsA total of fifteen guidelines/Consensuses Statements were included in the study. Two guidelines were assessed as recommended, eleven guidelines were assessed as recommended with modifications and two guidelines were not recommended. The mean scores of the included guidelines in the six domains (scope and purpose, personnel involved in guideline development, rigor of development, clarity, applicability, independence) were 90 percent, 72 percent, 49 percent, 96 percent, 60 percent, 69 percent, respectively. Thus, the study identified a consensus that disease risk factors and recommended interventions were mentioned in the guidelines, and that they comprehensively evaluated the quality of guideline reporting to provide reference for standardizing the development of practice guidelines for COPD in China.ConclusionsThe overall methodological quality of COPD CPGs should be improved. The key recommended areas for improvement include standardization of guideline report writing and synthesis of the latest and best evidence, to develop CPGs for COPD to improve the quality of clinical diagnosis and treatment for COPD.

Evidence or Clinicians or the Person

2016 ◽  
Vol 30 (1) ◽  
pp. 17-20 ◽  
Author(s):  
Kristine L. Florczak
Keyword(s):  
Decision Making ◽  
Evidence Based Practice ◽  
Models Of Care ◽  
Evidence Based ◽  
Healthcare Decision ◽  
Model Of Care ◽  
Healthcare Decision Making ◽  
Proposed Model ◽  
Practice Models

In this column, the issue of who should drive healthcare decision-making will be considered. To that end, evidence-based practice and evidence-informed practice models of care will be discussed. Problems with the use of each of these models will be brought to light followed by a presentation of a proposed model of care that puts the person at the center of healthcare decision- making.

scholarly journals Methods for the Development of Healthcare Practice Recommendations Using Systematic Reviews and Meta-Analyses

2021 ◽  
Vol 12 ◽  
Author(s):  
Thomas Platz
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Systematic Reviews ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Practice Recommendations ◽  
Meta Analyses

Quality of healthcare can be improved when the best external evidence available is integrated in clinical decision-making in a systematic explicit manner. With the rapid expansion of clinical evidence, the opportunities for evidence-based high-quality healthcare increase. Paradoxically, the likelihood of any one person to get a complete and balanced picture of the evidence available decreases. This is especially true for rehabilitation interventions that are complex in nature and where clinical research is rather diverse. Given the complex nature of the evidence, there is a substantial risk of misinterpreting the complex information both at the level of individual sources (e.g., reports of clinical trials) and for aggregated data syntheses (e.g., systematic reviews and meta-analyses). These risks are inherent in these sources themselves and are in addition related to the methodological expertise necessary to make valid use of the evidence for clinical decision-making. Taken together, there is a great demand for systematic structured guidance from evidence to clinical decision. This methodology paper describes a structured process for the development and report of evidence-based clinical practice recommendations that uses systematic reviews and meta-analyses as evidence source. It provides a comprehensive framework with specific requirements for the development group, the formulation of the healthcare question addressed, the systematic search for the evidence, its critical appraisal, the extraction and the outcome-centered presentation of the evidence, the rating of its quality, strengths and weaknesses, any further considerations relevant for decision-making, and an explicit recommendation statement along with its justification, implementation, and resource aspects. The suggested methodology uses international standards in evidence synthesis, critical appraisal of systematic reviews, rating the quality of evidence, characteristics of recommendations, and guideline development as developed by Cochrane, GRADE (Grading of Recommendations Assessment, Development and Evaluation), AMSTAR (A MeaSurement Tool to Assess systematic Reviews), and AGREE (Appraisal of Guidelines for REsearch & Evaluation). An added distinctive feature of the methodology is to focus on the most up-to-date, most valid evidence and hence to support the development of valid practice recommendations in an efficient way. Practice recommendations generated by such a valid methodology would be generally applicable and promote evidence-based clinical practice globally.

scholarly journals A Methodological Quality Assessment of Meta-Analysis Studies in Dance Therapy Using AMSTAR and AMSTAR 2

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 446
Author(s):  
Hye-Ryeon Kim ◽  
Chang-Hwan Choi ◽  
Eunhye Jo
Keyword(s):  
Decision Making ◽  
Dance Therapy ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Assessment Tools ◽  
Quality Level ◽  
Evidence Based ◽  
Evaluation Scores ◽  
Significant Difference

Although earlier meta-analysis studies have provided evidence-based information useful for decision-making, debate regarding their quality continues. This study aimed to evaluate the quality of meta-analysis studies in the field of dance therapy (DT) using the Assessment of Multiple Systematic Reviews (AMSTAR) and AMSTAR 2 assessment tools. Meta-analysis studies on DT were collected from various databases. Seven meta-analysis studies were selected for this study. Our findings showed that the quality level of the meta-analysis studies related to DT was “High” on the AMSTAR evaluation, but their quality decreased to “Low” on the AMSTAR 2 evaluation. Moreover, using AMSTAR 2, 71.43% of the studies fell within the category of “Moderate” or below. There was no statistically significant difference in the quality scores of the characteristics of these studies. Our results suggest that (1) education on meta-analysis guidelines is required to improve the quality of DT-related meta-analysis studies, and (2) methodological caution is warranted, since different outcomes in evaluation scores for each tool may be obtained when using AMSTAR and AMSTAR 2. Based on this study, it is expected that common and specific guidelines for meta-analysis in DT can be established.

scholarly journals IDENTIFICATION OF MULTI-STAKEHOLDER VALUE IN MEDICAL DECISION-MAKING

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Karen Moons ◽  
Liliane Pintelon ◽  
Pieterjan Jorissen ◽  
Dirk De Ridder ◽  
Wouter Everaerts
Keyword(s):  
Decision Making ◽  
Quality Of Care ◽  
Radical Prostatectomy ◽  
Medical Decision ◽  
Healthcare Decision ◽  
Healthcare Decision Making ◽  
Definition Of ◽  
Multi Stakeholder

The recent trend is towards value-based healthcare, which is characterized by the relationship between quality of care and the associated costs. However, value in healthcare is a largely unmeasured and misunderstood concept. In particular, a definition of multi-stakeholder value in healthcare decision-making is missing. In this case study, we review the radical prostatectomy procedure because previous studies have shown discrepancies between what the patient’s value most and what the experts think the patient’s value most. The objective of this research is to address this gap by identifying a multi-stakeholder definition of value which will improve healthcare decision-making. Multi-criteria decision-making (MCDM) techniques, more specifically the Analytic Hierarchy Process (AHP), are applied to prioritize the quality of care indicators according to the following six pillars of quality: safety, effectiveness, efficiency, timeliness, patient-centeredness and equity. In addition, the average cost of a radical prostatectomy is estimated. A distinction is made between three treatment stages in order to calculate the overall quality score by assigning weights to criteria in each treatment stage. According to the AHP weights, the pillars of effective, patient-centered and equitable care contribute the most to value creation. Finally, some of the challenges of MCDM studies are addressed, such as conflicting preferences between stakeholder groups. In conclusion, this case study stresses the need to adapt operational research methods and knowledge to be applied in value-based healthcare. The AHP is a suitable approach to address the needs of healthcare decision-makers, to set priorities, and to identify value improvement opportunities while considering all of the stakeholders involved in the full care cycle.  

scholarly journals Systematic and integrative reviews: synthesising evidence for community nursing practice

2020 ◽  
Vol 25 (1) ◽  
pp. 6-9
Author(s):  
Catriona Kennedy ◽  
Mokholelana Margaret Ramukumba
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Nursing Practice ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Evidence Synthesis ◽  
Clinical Decision ◽  
Evidence Based ◽  
The Status ◽  
Ease Of Access

Ease of access to vast amounts of information presents significant opportunities and challenges for nurses in the community as they seek to base their practice on the best available evidence. Growing expectations around evidence-based practice have developed alongside developments in evidence synthesis, which adopts robust approaches to identifying, appraising and synthesising key evidence for clinical decision-making. The context in which evidence-based practice occurs is key, and this article discusses the skills and knowledge needed for community nurses to discern how evidence and information should influence their decisions to review and change approaches to clinical practice. Importantly, if nurses understand the status of evidence underpinning areas of practice, they can ensure that the preferences and needs of patients and families are met.

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