中国循证医学杂志

中国循证医学杂志

中国临床路径的证据来源调查

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目的分析目前我国临床路径证据的来源情况。方法从国家卫生和计划生育委员会网站获取已批准的临床路径,由 2 名研究者独立提取资料,对路径的发布时间、关注疾病、证据报告等方面进行描述性分析。对路径诊断和治疗部分不同证据发表与路径发布时间间隔进行方差分析并使用 LSD 法进行两两比较。结果临床路径引用证据的类型主要为指南、教科书、标准指标和共识意见。其中约 80% 引用了临床实践指南,36% 引用了教科书。每个路径引用证据数量的中位数为 2 个。85% 的证据报告了其发表时间,路径发布与证据发表的平均时间间隔为 5.2 年,在时间间隔大于 15 年的证据中占比最大的为教科书。除教科书对比标准指标的时间间隔外,其他证据发表与路径发布时间间隔的两两比较均有显著差异(P<0.05)。结论我国临床路径的证据类型选择基于循证医学的理念,但引用证据的时间范围跨度较大。制定临床路径时,要重视最新的研究证据,增强临床路径制订过程的透明性,采用证据质量评价标准对引用证据进行评价和选择。

ObjectivesTo investigate sources of evidence of the clinical pathways approved by the Chinese government.MethodsThe approved clinical pathways were obtained from the website of the National Health and Family Planning Commission. Two reviewers independently extracted the basic information, approval date, types of evidence of the clinical pathways and time of evidence. The variance analysis was performed for the diagnosis and treatment parts of clinical pathways and the LSD method was further used for comparison.ResultsThe main types of evidence were guidelines, textbooks, standard indicators and consensus views. Approximately 80% of the pathways cited clinical practice guidelines and 36% cited the textbooks. The median number of evidence for each clinical pathway was 2. Approximately 85% of the evidence could be obtained the time when the evidence published. The average time interval (between the time when the pathways released and the time when the evidence published) was 5.2 years. Specifically, textbooks constituted the largest proportion in all evidence that was over 15 years of time interval. In addition to the textbook comparison standard indicators, there were significant differences in time interval between guidelines or consensus and textbooks or standard indicators.Conclusions The evidence types selection is based on the concept of evidence-based medicine, yet the time span of the referred evidence is larger. Therefore, developing clinical pathways not only need to refer to the latest research evidence comprehensively and enhance transparency of clinical pathways, but also use evidence quality evaluation standards to evaluate and select the referred evidences.

关键词: 临床路径; 循证医学; 证据

Key words: Clinical pathways; Evidence-based Medicine; Evidence

引用本文: 荀杨芹, 成鹏, 李秀霞, 韦当, 姚亮, 潘蓓, 闫沛静, 许可, 李亚男, 郭天康, 杨克虎. 中国临床路径的证据来源调查. 中国循证医学杂志, 2018, 18(10): 1032-1036. doi: 10.7507/1672-2531.201801133 复制

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