Saura-Llamas J, Saturno Hernández P J, Romero Román J R, Gaona Ramón J M, Gascón Cánovas J J
Especialista en Medicina Familiar y Comunitaria, Centro de Salud Barrio del Carmen, Murcia, Spain.
Aten Primaria. 2001 Nov 15;28(8):525-34. doi: 10.1016/s0212-6567(01)70442-8.
To identify characteristics associated with greater structural quality of clinical guidelines.
Cross-sectional study.
Health centers in the region of Murcia (southeastern Spain).
All clinical practice guidelines and protocols developed between January 1985 and January 1994 were reviewed. Of the 470 documents originally obtained, 462 were evaluated and 8 were excluded because of missing data. The quality of document design was evaluated in all materials. The rate of criteria compliance was calculated for each document. The characteristics that were associated with protocol quality were identified in two types of multivariate analysis: multiple regression (with compliance rate as the dependent variable) and logistic regression (with compliance rate referred to the mean as the dependent variable).
Both analyses showed that structural quality was associated with specific health care areas, multidisciplinary design (p < 0.001), reference to chronic health problems (p < 0.001), design of the document specifically as a clinical practice guideline (p < 0.001), and reference to the health services offered at a given center (p < 0.001). In some analyses, greater quality appeared to be associated with heath centers that were also teaching centers, reference in the document to health care, and womens health programs.
Document quality varied significantly in different health care areas, and certain characteristics (chronic health problems, multidisciplinary design and specific design, reference to specific health services offered) were associated with greater document quality. Reference to acute health problems, design by only one type of professional (physicians or nurses), inclusion as part of a larger program, and lack of reference to specific health services offered at a given center were characteristics with a greater risk for low document quality.
确定与临床指南更高结构质量相关的特征。
横断面研究。
穆尔西亚地区（西班牙东南部）的健康中心。
对1985年1月至1994年1月期间制定的所有临床实践指南和方案进行审查。在最初获得的470份文件中，462份进行了评估，8份因数据缺失被排除。对所有材料的文件设计质量进行评估。计算每份文件的标准符合率。通过两种多变量分析确定与方案质量相关的特征：多元回归（以符合率作为因变量）和逻辑回归（以相对于均值的符合率作为因变量）。
两项分析均表明，结构质量与特定医疗领域、多学科设计（p<0.001）、对慢性健康问题的提及（p<0.001）、专门作为临床实践指南的文件设计（p<0.001）以及对特定中心提供的卫生服务的提及（p<0.001）相关。在一些分析中，更高的质量似乎与也是教学中心的健康中心、文件中对医疗保健的提及以及妇女健康项目相关。
不同医疗领域的文件质量差异显著，某些特征（慢性健康问题、多学科设计和特定设计、对特定提供的卫生服务的提及）与更高的文件质量相关。提及急性健康问题、仅由一种专业人员（医生或护士）进行设计、作为更大项目的一部分纳入以及未提及特定中心提供的卫生服务是文件质量低风险更高的特征。
