Woolf S H
Office of Disease Prevention and Health Promotion, Washington, DC 20201.
Arch Intern Med. 1992 May;152(5):946-52.
Current methods for developing practice guidelines include informal consensus development, formal consensus development, evidence-based guideline development, and explicit guideline development. Informal consensus development is the oldest and most common approach, but guidelines produced in this manner are often of poor quality and lack adequate documentation of methods. Formal consensus development uses a systematic approach to assess expert opinion and to reach agreement on recommendations. Evidence-based guideline development links recommendations directly to scientific evidence of effectiveness; rules of evidence are emphasized over expert opinion in making recommendations. Explicit guideline development clarifies the rationale by specifying the potential benefits, harms, and costs of available interventions; estimating the possibility of the outcomes; and comparing the desirability of the outcomes based on patient preferences. Steps in the development of practice guidelines include introductory decisions (selection of topic and panel members, clarification of purpose); assessments of clinical appropriateness (review of scientific evidence and expert opinion); assessment of public policy issues (resource limitations, feasibility issues); and guideline document development and evaluation (drafting of document, peer review, and pretesting).
当前制定实践指南的方法包括非正式共识制定、正式共识制定、循证指南制定和明确指南制定。非正式共识制定是最古老且最常见的方法，但以这种方式产生的指南往往质量较差，且缺乏对方法的充分记录。正式共识制定采用系统方法来评估专家意见并就建议达成一致。循证指南制定将建议直接与有效性的科学证据联系起来；在提出建议时，证据规则比专家意见更受重视。明确指南制定通过明确可用干预措施的潜在益处、危害和成本；估计结果的可能性；并根据患者偏好比较结果的可取性来阐明基本原理。实践指南制定的步骤包括初步决策（主题和小组成员的选择、目的的阐明）；临床适宜性评估（科学证据和专家意见的审查）；公共政策问题评估（资源限制、可行性问题）；以及指南文件的制定和评估（文件起草、同行评审和预测试）。
