Nathwani D, Rubinstein E, Barlow G, Davey P
Infection and Immunodeficiency Unit, Tayside University Hospitals, National Health Service Trust, Dundee DD3 8EA, United Kingdom.
Clin Infect Dis. 2001 Mar 1;32(5):728-41. doi: 10.1086/319216. Epub 2001 Feb 28.
There is growing pressure to demonstrate the value of practice guidelines. We have reviewed the evidence that guidelines for the treatment of community-acquired pneumonia (CAP) change current practices and that the standardization of practices reduces costs and/or improves outcome. The most obvious barrier to implementation of the guidelines is lack of knowledge about their content; equally important are the attitudes and behavior of professionals, patients, and their caregivers. Guidelines may improve the outcome of CAP, provided that there is an association between variations in outcome and some specific processes of care. Conversely, when there is no such relationship, guidelines may reduce the cost of care without having an adverse effect on outcome. The cost-effectiveness of CAP guidelines in an individual hospital depends on the systems that are available to identify patients with CAP and to measure the processes of care. There is good evidence that following the recommendations of the CAP guidelines does improve the cost-effectiveness of care and, therefore, that an audit of CAP may be worth the effort.
证明实践指南的价值所面临的压力日益增大。我们已审视了相关证据，即社区获得性肺炎（CAP）治疗指南改变了当前的医疗实践，且医疗实践的标准化降低了成本和/或改善了治疗结果。实施这些指南最明显的障碍是对其内容缺乏了解；同样重要的是专业人员、患者及其护理人员的态度和行为。如果治疗结果的差异与某些特定护理流程之间存在关联，那么指南可能会改善CAP的治疗结果。相反，当不存在这种关系时，指南可能会降低护理成本，而不会对治疗结果产生不利影响。单个医院中CAP指南的成本效益取决于用于识别CAP患者和衡量护理流程的现有系统。有充分证据表明，遵循CAP指南的建议确实能提高护理的成本效益，因此，对CAP进行审核可能是值得的。
