Perleth M, Jakubowski E, Busse R
Hannover Medical School, Department of Epidemiology, Social Medicine and Health System Research, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Health Policy. 2001 Jun;56(3):235-50. doi: 10.1016/s0168-8510(00)00138-x.
A framework for the classification of information on maintaining or improving effectiveness and efficiency in health care systems is proposed. Activities, disciplines and methods that are available to identify, implement and monitor the available evidence in health care are called 'best practice'. We reviewed the literature in order to (1) establish a definition for 'best practice' in the health sector, (2) develop a framework to classify relevant information, and (3) synthesise the literature on activities, disciplines and methods pertinent to the concept. Health care, public health activities and health policy should be advised by the best available evidence. Currently, the concept can be broken down into three activities (Health Technology Assessment (HTA), Evidence-Based Medicine (EBM), Clinical Practice Guidelines (CPGs)) by which evidence is synthesised either as an evidence base (EBM and most HTA) or in the form of recommendations (CPGs and some HTA) for different decision purposes in health care. These activities gain input mainly through four disciplines: clinical research, clinical epidemiology, health economics and health services research. The different disciplines are related to each other in three 'domains': (a) input, (b) dissemination/implementation and (c) monitoring/outcome. These provide evidence on (a) the (potential) effects of health care interventions and policies; (b) on ways to implement them; and (c) on ways to monitor their actual outcome. None of these separate approaches and activities exclusively forms a successful and all-embracing strategy to ascertain 'best practice'. A collective approach in the management of information is expected to add value to individual efforts. Resources should be devoted to increase quality and quantity of both primary and secondary research as well as the establishment of networks to synthesise, disseminate, implement and monitor 'best practice'.
本文提出了一个用于对医疗保健系统中维持或提高有效性和效率的信息进行分类的框架。用于识别、实施和监测医疗保健领域现有证据的活动、学科和方法被称为“最佳实践”。我们回顾了相关文献，目的是：（1）为卫生部门的“最佳实践”确立定义；（2）制定一个对相关信息进行分类的框架；（3）综合有关与该概念相关的活动、学科和方法的文献。医疗保健、公共卫生活动和卫生政策应以现有最佳证据为依据。目前，这一概念可细分为三项活动（卫生技术评估（HTA）、循证医学（EBM）、临床实践指南（CPG）），通过这些活动，证据被综合为证据库（EBM和大多数HTA）或建议形式（CPG和一些HTA），以用于医疗保健中的不同决策目的。这些活动主要通过四个学科获得信息输入：临床研究、临床流行病学、卫生经济学和卫生服务研究。不同学科在三个“领域”相互关联：（a）输入；（b）传播/实施；（c）监测/结果。这些领域提供了关于以下方面的证据：（a）医疗保健干预措施和政策的（潜在）效果；（b）实施这些措施和政策的方法；（c）监测其实际结果的方法。这些单独的方法和活动都不能单独形成一种成功且全面的策略来确定“最佳实践”。预计在信息管理方面采用集体方法将为个人努力增添价值。应投入资源以提高初级和二级研究的质量和数量，并建立网络来综合、传播、实施和监测“最佳实践”。
