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Research on promotion of implementation of clinical practice guidelines(I):the status of implementation and promotion strategies

Published on Dec. 24, 2021Total Views: 5621 timesTotal Downloads: 2599 timesDownloadMobile

Author: Xu-Hui LI 1 Qiao HUANG 1 Yong-Bo WANG 1 Si-Yu YAN 1 Mu-Kun CHEN 2, 3 Kuang GAO 2, 3 Yi-Bei SI 1, 4 Jing GUO 1, 5 Wen-Bin HU 2, 3 Ying-Hui JIN 1

Affiliation: 1. Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China 2. School of Computer Science, Wuhan University, Wuhan 430072, China 3. Artificial Intelligence Institute of Wuhan University, Wuhan 430072, China 4. The Second Clinical College, Wuhan University, Wuhan 430071, China 5. Acupuncture and Rehabilitation Department, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China

Keywords: Clinical practice guideline Implementation Promotion strategies

DOI: 10.12173/j.issn.1004-5511.202111064

Reference: Li XH, Huang Q, Wang YB, Yan SY, Chen MK, Gao K, Si YB, Guo J, Hu WB, Jin YH. Research on promotion of implementation of clinical practice guidelines (Ⅰ): the status of implementation and promotion strategies[J]. Yixue Xinzhi Zazhi, 2021, 31(6): 410-418. DOI: 10.12173/j.issn.1004-5511.202111064.[Article in Chinese]

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Abstract

The implementation of clinical practice guidelines is an important form of evidence transformation and a main way to narrow the gap between research results and clinical practice. Af-fected by factors such as low operability, single form of dissemination and application, not timely update, and lack of implementation tools and implementation evaluation tools, the implementation of clinical practice guidelines is still insufficient. Combining the evidence ecosystem framework, constructing guideline implementation evaluation tools, and using knowledge graph and other artificial intelligence technologies to provide theoretical support, effect evaluation tools, and technical paths for the imple-mentation of the guidelines are effective methods to promote the implementation of clinical practice guidelines.

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References

1.Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Clinical practice guidelines we can trust[M]. Washington (DC): National Academies Press, 2011. DOI: 10.172 26/13058.

2.林夏, 杨克虎, 陈耀龙, 等. 中国临床实践指南的现状与思考[J]. 中国循证医学杂志, 2017, 17(5): 497-500. DOI: 10.7507/1672-2531.201703130. [Lin X, Yang KH, Chen YL, et al. Clinical practice guideline in China: cur-rent status and thoughts[J]. Chinese Journal of Evidence-Based Medicine, 2017, 17(5): 497-500.]

3.赵俊强. 引入复杂科学理念,推动实施科学研究范式的多样化[J]. 医学新知, 2020, 30(5): 364-375. DOI: 10.12173/j.issn.1004-5511.2020.05.05. [Zhao JQ. When complexity science meets with implementation science: a call for paradigm diversification in implementation research[J]. Yixue Xinzhi Zazhi, 2020, 30(5): 364-375.]

4.王云云, 黄桥, 靳英辉, 等. 临床实践指南实施关键环节方法分析[J]. 中国循证心血管医学杂志, 2020, 12(1): 5-9, 13. DOI: 10.3969/j.issn.1674-4055.2020.01.02. [Wang YY, Huang Q, Jin YH, et al. The methodology of key steps in impelementation for clinical practice guideline[J]. Chinese Journal of Evidence-Based Cardio-vascular Medicine, 2020, 12(1): 5-9, 13.]

5.Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research[J]. J R Soc Med, 2011, 104(12): 510-520. DOI: 10.1258/jrsm.2011.110180.

6.靳英辉, 邓通, 曾宪涛, 等. 临床实践指南制订方法——指南的实施与转化[J]. 中国循证心血管医学杂志, 2019, 11(9): 1040-1042, 1046. DOI: 10.3969/j.issn.1674-4055.2019.09.03. [Jin YH, Deng T, Zeng  XT, et al. Method-ology for clinical practice guidelines—implementation and transformation of guidelines[J]. Chinese Journal of Evidence-Based Cardiovascular Medicine, 2019, 11(9): 1040-1042, 1046.]

7.Sheng F, Fang W, Zhang B, et al. Adherence to gout management recommendations of Chinese pa-tients[J]. Medicine (Baltimore), 2017, 96(45): e8532. DOI: 10.1097/md.0000000000008532.

8.Liu M, Zhang C, Zha Q, et al. A national survey of Chinese medicine doctors and clinical practice guide-lines in China[J]. BMC Complement Altern Med, 2017, 17(1): 451. DOI: 10.1186/s12906-017-1946-2.

9.Zeng L, Li Y, Zhang L, et al. Guideline use behaviours and needs of primary care practitioners in China: a cross-sectional survey[J]. BMJ Open, 2017, 7(9): e015379. DOI: 10.1136/bmjopen-2016-015379.

10.陈耀龙, 姚亮, 王琪, 等. 甘肃省皋兰县基层医务工作者对临床实践指南的认知、态度与行为调查[J]. 中国循证医学杂志, 2014, 14(6): 674-677. DOI: 10.7507/167 2-2531.20140115. [Chen YL, Yao L, Wang Q, et al. Survey on knowledge, attitude and behaviour regarding clinical practice guidelines of primary healthcare work-ers in Gaolan county of Gansu province[J]. Chinese Journal of Evidence-Based Medicine, 2014, 14(6): 674-677.]

11.Chen Y, Wang C, Shang H, et al. Clinical practice guidelines in China[J]. BMJ, 2018, 360: j5158. DOI: 10.1136/bmj.j5158.

12.陈耀龙, 刘萧, 王燕平, 等. 西医指南与中医药指南: 在相互学习中共同提高[J]. 协和医学杂志, 2020, 11(5): 615-620. DOI: 10.3969/j.issn.1674-9081.2020.05.019. [Chen YL, Liu X, Wang YP, et al. Western medical guidelines and traditional Chinese medical guidelines: improving together through mutual learning[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(5): 615-620.]

13.Yuwen Y, Shi NN, Wang LY, et al. Development of clinical practice guidelines in 11 common diseases with Chinese medicine interventions in China[J]. Chin J Integr Med, 2012, 18(2): 112-119. DOI: 10.1007/s11655-012-0997-y.

14.Jin Y, Li Z, Han F, et al. Barriers and enablers for the implementation of clinical practice guidelines in China: a mixed-method study[J]. BMJ Open, 2019, 9(9): e026328. DOI: 10.1136/bmjopen-2018-026328.

15.Jin YH, Tan LM, Khan KS, et al. Determinants of successful guideline implementation: a national cross-sectional survey[J]. BMC Med Inform Decis Mak, 2021, 21(1): 19. DOI: 10.1186/s12911-020-01382-w.

16.Houghton C, Meskell P, Delaney H, et al. Barriers and facilitators to healthcare workers' adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qual-itative evidence synthesis[J]. Cochrane Database Syst Rev, 2020, 4(4): CD013582. DOI: 10.1002/14651858.Cd013582.

17.Gagliardi AR, Marshall C, Huckson S, et al. Developing a checklist for guideline implementation plan-ning: review and synthesis of guideline development and implementation advice[J]. Implement Sci, 2015, 10: 19. DOI: 10.1186/s13012-015-0205-5.

18.Zhao J, Demery Varin M, Graham ID. Guidelines do not self-implement: time for a research paradigm shift from massive creation to effective implementation in evidence-based medicine research in Chi-na[J]. BMJ Evid Based Med, 2020, 25(4):118-119. DOI: 10.1136/bmjebm-2019-111193.

19.Correa VC, Lugo-Agudelo LH, Aguirre-Acevedo DC, et al. Individual, health system, and contextual bar-riers and facilitators for the implementation of clinical practice guidelines: a systematic metareview[J]. Health Res Policy Syst, 2020, 18(1): 74. DOI: 10.1186/s12961-020-00588-8.

20.Brignardello-Petersen R, Carrasco-Labra A, Guyatt GH. How to interpret and use a clinical practice guideline or recommendation: users' guides to the medical literature[J]. JAMA, 2021, 326(15): 1516-1523. DOI: 10.1001/jama. 2021.15319.

21.张霄潇, 冯雪, 廖星, 等. 中医临床实践指南报告清单[J]. 中华中医药杂志, 2019, 34(9): 4379-4384. DOI: CNKI:SUN:BXYY.0.2019-09-128. [Zhang XX, Feng X, Liao X, et al. Checklist for the reporting of clinical practice guideline of traditional Chinese medicine[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2019, 34(9): 4379-4384.]

22.Bierbaum M, Rapport F, Arnolda G, et al. Clinicians' attitudes and perceived barriers and facilitators to cancer treatment clinical practice guideline adherence: a systematic review of qualitative and quanti-tative literature[J]. Implement Sci, 2020, 15(1): 39. DOI: 10.1186/s13012-020-00991-3.

23.张迎萍, 范玉玲, 胡青, 等. 临床实践指南结构化和知识化处理研究综述[J]. 情报工程, 2018, 4(2): 4-25. DOI: 10.3772/j.issn.2095-915x.2018.02.002. [Zhang YP, Fan YL, Hu Q, et al. A survey of computerization of clinical practice guidelines[J]. Technology Intelligence Engineering, 2018, 4(2): 4-25.]

24.尹梓名, 杜方芮, 赵紫彤, 等. 基于临床指南的知识图谱构建技术研究[J]. 软件, 2020, 41(9): 178-184, 197. DOI: 10.3969/j.issn.1003-6970.2020.09.047. [Yin ZM, Du FR, Zhao ZT, et al. Research on knowledge graph construction technology based on clinical guidelines[J]. Computer engineering & Software, 2020, 41(9): 178-184, 197.]

25.Heen AF, Vandvik PO, Brandt L, et al. A framework for practical issues was developed to inform shared decision-making tools and clinical guidelines[J]. J Clin Epidemiol, 2021, 129: 104-113. DOI: 10.1016/j.jclinepi.2020.10.002.

26.Vandvik PO, Brandt L, Alonso-Coello P, et al. Creating clinical practice guidelines we can trust, use, and share: a new era is imminent[J]. Chest, 2013, 144(2): 381-389. DOI: 10.1378/chest.13-0746.

27.Siemieniuk RA, Agoritsas T, Macdonald H, et al. Introduction to BMJ rapid recommendations[J]. BMJ, 2016, 354: i5191. DOI: 10.1136/bmj.i5191.

28.曾可. 基于本体技术的中文临床指南计算机化研究 [D]. 武汉: 华中科技大学, 2017. [Zeng K. Research on computerization of Chinese clinical guidelines based on ontology technology[D]. Wuhan: Huazhong University of science and technology, 2017.]

29.Martínez García L, Sanabria AJ, García Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis[J]. CMAJ, 2014, 186(16): 1211-1219. DOI: 10.1503/cmaj.140547.

30.陈耀龙, 王小琴, 吴琼芳, 等. 中国临床实践指南更新情况调查[J]. 中国循证医学杂志, 2014, 14(2): 178-183. DOI: CNKI:SUN:ZZXZ.0.2014-02-012. [Chen YL, Wang XQ, Wu QF, et al. Investigation on the update of clini-cal practice guidelines in China[J]. Chinese Journal of Evidence-Based Medicine, 2014, 14(2): 178-183.]

31.王怡杨, 李悠悠, 贾贝田, 等. 中国中西医结合临床实践指南及专家共识质量评价[J]. 中国中西医结合杂志, 2020, 40(6): 672-678. DOI: 10.7661/j.cjim.20200212. 003. [Wang YY, Li YY, Jia BT, et al. Quality evaluation of clinical practice guidelines and expert consensus of integrated Chinese and Western medicine in Chi-na[J]. Chinese Journal of Integrated Traditional and Western Medicine, 2020, 40(6): 672-678.]

32.Gagliardi AR, Brouwers MC, Palda VA, et al. How can we improve guideline use? A conceptual frame-work of implementability[J]. Implement Sci, 2011, 6: 26. DOI: 10.1186/1748-5908-6-26.

33.Gagliardi AR. "More bang for the buck": exploring optimal approaches for guideline implementation through interviews with international developers[J]. BMC Health Serv Res, 2012, 12: 404. DOI: 10.1186/1472-6963-12-404.

34.Flodgren G, Hall AM, Goulding L, et al. Tools developed and disseminated by guideline producers to promote the uptake of their guidelines[J]. Cochrane Database Syst Rev, 2016, (8): CD010669. DOI: 10.1002/14651858.CD010669.pub2.

35.Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care[J]. CMAJ, 2010, 182(18): E839-E842. DOI: 10.1503/cmaj.090449.

36.王吉耀.制定临床实践指南评价的“中国标准”[J]. 中华医学杂志, 2018, 98(20): 1542-1543. DOI: 10.3760/cma.j.issn.0376-2491.2018.20.003. [Wang JY. Formulate the "Chinese standard" for the evalua-tion of clinical practice guidelines[J]. National Medical Journal of China, 2018, 98(20): 1542-1543.]

37.黄超, 杜亮, 陈耀龙, 等. 中国医务人员对临床实践指南的使用和需求调查[J]. 中国循证医学杂志, 2019, 19(6): 635-638. DOI: 10.7507/1672-2531.201806054. [Huang C, Du L, Chen YL, et al. Usage and demand for clinical practice guidelines among Chinese health practitioners[J]. Chinese Journal of Evidence-Based Medicine, 2019, 19(6): 635-638.]

38.WHO. Handbook for guideline development (2nd edition)[EB/OL]. (2014) [Access on 2021-10-20]. http://www.who.int/publications/guidelines/handbook_2nd_ed.pdf?ua=1.

39.NICE. Developing nice guidelines, the manual[EB/OL]. (2014-10-31) [Access on 2021-10-20]. https://www.nice.org.uk/process/pmg20/chapter/introduction.

40.MAGIC. The digital and trustworthy evidence ecosystem 2021[EB/OL]. [Access on 2021-10-20]. https://magicevidence.org/.

41.周英凤, 钟婕, 李丽, 等. 构建证据生态系统,推动循证护理实践发展[J]. 护士进修杂志, 2019, 34(3): 193-197. DOI: 10.16821/j.cnki.hsjx.2019.03.001. [Zhou YF, Zhong J, Li L, et al. Constructing evidence ecosystem to promote the development of evidence-based nursing practice [J]. Journal of Nurses Training, 2019, 34(3): 193-197.]

42.靳英辉, 邓通, 曾宪涛, 等. 临床实践指南制订方法——指南的实施工具[J]. 中国循证心血管医学杂志, 2019, 11(10): 1157-1161. DOI: 10.3969/j.issn.1674-4055.2019.10.02. [Jin YH, Deng T, Zeng XT, et al. Methodology for clinical practice guidelines --implementation tools of guidelines[J]. Chinese Journal of Evidence-Based Cardiovascular Medicine, 2019, 11(10): 1157-1161.]

43.靳英辉, 赵志慧, 黄粲然,等. 临床实践指南实施性评价工具的研制和验证评价[J]. 中国循证医学杂志, 2021, 21(12): 1-9. DOI: 10.7507/1672-2531.202106002. [Jin YH, Zhao ZH, Huang CR, et al. Development and valida-tion of a practical evaluation tool for clinical practice guidelines[J]. Chinese Journal of Evidence Based Medicine, 2021, 21(12): 1-9.]

44.陈耀龙, 罗旭飞, 史乾灵, 等. 人工智能如何改变指南的未来[J]. 协和医学杂志, 2021, 12(1): 114-121. DOI: 10.12290/xhyxzz.2021-0012. [Chen YL, Luo XF, Shi QL, et al. How will artificial intelligence lead the fu-ture of clinical practice guidelines[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(1): 114-121.]

45.李博, 李科, 曾东, 等. 基于语义关系的高血压临床指南知识库构建[J]. 中国数字医学, 2013, 8(9): 64-67. DOI: 10.3969/j.issn.1673-7571.2013.09.022. [Li B, Li K, Zeng D, et al. Construction of hypertension clinical guideline knowledge base based on semantic[J]. China Digital Medicine, 2013, 8(9): 64-67.]

46.蒲晓蓉, 陈柯成, 刘军池, 等. COVID-19中国诊疗方案的机器学习智能分析方法[J]. 生物医学工程学杂志, 2020, 37(3): 365-372. DOI: 10.7507/1001-5515. 202003045. [Pu XR, Chen KC, Liu JC, et al. Machine learn-ing-based method for interpreting the guidelines of the diagnosis and treatment of COVID-19[J]. Journal of Biomedical Engineering, 2020, 37(3): 365-372.]

47.Jin Y, Ren X, Yu L, et al. Artificial intelligence for the development and implementation guidelines for traditional Chinese medicine and integrated traditional Chinese and Western medicine[J]. TMR Mod-ern Herb Med, 2021, 4: 9-14. DOI: 10.12032/MHM2021B0219001.

48.Beller E, Clark J, Tsafnat G, et al. Making progress with the automation of systematic reviews: princi-ples of the international collaboration for the automation of systematic reviews (ICASR)[J]. Syst Rev, 2018, 7(1): 77. DOI: 10.1186/s13643-018-0740-7.

49.Clark J, Glasziou P, Del Mar C, et al. A full systematic review was completed in 2 weeks using automa-tion tools: a case study[J]. J Clin Epidemiol, 2020, 121: 81-90. DOI: 10.1016/j.jclinepi.2020.01.008.

50.Hussain M, Hussain J, Ali T, et al. Text classification in clinical practice guidelines using ma-chine-learning assisted pattern-based approach[J]. Appl Sci, 2021, 11(8): 3296. DOI: 10.3390/app11083296.

51.Somashekhar SP, Sepúlveda MJ, Puglielli S, et al. Watson for oncology and breast cancer treatment recommendations: agreement with an expert multidisciplinary tumor board[J]. Ann Oncol, 2018, 29(2): 418-423. DOI: 10.1093/annonc/mdx781.

52.Xu F, Sepúlveda MJ, Jiang Z, et al. Artificial intelligence treatment decision support for complex breast cancer among oncologists with varying expertise[J]. JCO Clin Cancer Inform, 2019, 3: 1-15. DOI: 10.1200/cci.18.00159.

53.Lu F, Cong P, Huang X. Utilizing textual information in knowledge graph embedding: a survey of methods and applications[J]. IEEE Access, 2020, PP(99): 11. DOI: 10.1109/ACCESS.2020.2995074.

54.Wang Q, Mao Z, Wang B, et al. Knowledge graph embedding: a survey of approaches and applica-tions[J]. IEEE Transactions on Knowledge & Data Engineering,  2017, 29(12): 2724-2743. DOI: 10.1109/TKDE.2017. 2754499.

55.侯梦薇, 卫荣, 陆亮, 等. 知识图谱研究综述及其在医疗领域的应用[J]. 计算机研究与发展, 2018, 55(12): 2587-2599. DOI: 10.7544/issn1000-1239.2018.20180623. [Hou MW, Wei R, Lu L, et al. Research review of knowledge graph and its application in medical domain[J]. Journal of Computer Research and De-velopment, 2018, 55(12): 2587-2599.]

56.孙郑煜, 鄂海红, 宋美娜, 等. 基于大数据技术的医学知识图谱构建方法[J]. 软件, 2020, 41(1): 13-17. DOI: 10.3969/j.issn.1003-6970.2020.01.003. [Sun ZY, E HH, Song MN, et al. The method of medical knowledge graphs construction based on big data technology[J]. Computer engineering & Software, 2020, 41(1): 13-17.]