Gartlehner Gerald, West Suzanne L, Lohr Kathleen N, Kahwati Leila, Johnson Jana G, Harris Russell P, Whitener Lynn, Voisin Christiane E, Sutton Sonya
Cecil G. Sheps Center for Health Services Research, University of North Carolina, 725 Airport Road, Chapel Hill, NC 27599-7590, USA.
Int J Qual Health Care. 2004 Oct;16(5):399-406. doi: 10.1093/intqhc/mzh081.
An important concern for developers of clinical practice guidelines is how best to determine when guidelines require updating to ensure they remain current and evidence based. Because of the high costs associated with updating guidelines, recent attention has focused on approaches that can reliably assess the extent of updating required. Recently, Shekelle and colleagues proposed a model of limited literature searches with modest expert involvement as a way to reduce the cost and time requirements for assessing whether a guideline needs updating.
The main objective of this study was to compare the Shekelle et al. assessment model (review approach) and a conventional process using typical systematic review methods (traditional approach) in terms of comprehensiveness and effort. We modeled the review approach on that by Shekelle and colleagues but refined it iteratively over three phases to achieve greater efficiency. Using both methods independently, we assessed the need to update six topics from the 1996 Guide to Clinical Preventive Services from the US Preventive Services Task Force. Main outcomes included completeness of study identification, importance of missed studies and the effort involved.
Although the review approach identified fewer eligible studies than the traditional approach, none of the studies missed was rated as important by task force members acting as liaisons to the project with respect to whether the topic required an update. On average, the review approach produced substantially fewer citations to review than the traditional approach. The effort involved and potential time saving depended largely on the scope of the topic.
The revised review approach provides an efficient and acceptable method for judging whether a guideline requires updating.
临床实践指南开发者面临的一个重要问题是如何最好地确定指南何时需要更新，以确保其与时俱进且基于证据。由于更新指南成本高昂，近期的关注焦点集中在能够可靠评估所需更新程度的方法上。最近，谢凯乐及其同事提出了一种有限文献检索并适度专家参与的模式，作为降低评估指南是否需要更新的成本和时间要求的一种方式。
本研究的主要目的是在全面性和工作量方面比较谢凯乐等人的评估模式（综述方法）和使用典型系统综述方法的传统流程（传统方法）。我们以谢凯乐及其同事的模式为蓝本构建综述方法，但在三个阶段进行迭代优化以提高效率。我们分别使用这两种方法评估了美国预防服务工作组1996年《临床预防服务指南》中六个主题的更新需求。主要结果包括研究识别的完整性、遗漏研究的重要性以及所涉及的工作量。
尽管综述方法识别出的合格研究比传统方法少，但就主题是否需要更新而言，作为项目联络人的工作组成员认为，没有一项遗漏的研究被评为重要。平均而言，综述方法产生的待审查引文比传统方法少得多。所涉及的工作量和潜在的时间节省在很大程度上取决于主题的范围。
修订后的综述方法为判断指南是否需要更新提供了一种高效且可接受的方法。
