Fervers Béatrice, Burgers Jako S, Haugh Margaret C, Latreille Jean, Mlika-Cabanne Najoua, Paquet Louise, Coulombe Martin, Poirier Mireille, Burnand Bernard
Unité d'évaluation des soins, Iumsp, Hospices-Chuv, Lausanne, Switzerland.
Int J Qual Health Care. 2006 Jun;18(3):167-76. doi: 10.1093/intqhc/mzi108.
The development and updating of high-quality clinical practice guidelines require substantial resources. Many guideline programmes throughout the world are using similar strategies to achieve similar goals, resulting in many guidelines on the same topic. One method of using resources more efficiently and avoiding unnecessary duplication of effort would be to adapt existing guidelines. The aim was to review the literature on adaptation of guidelines and to propose a systematic approach for adaptation of guidelines.
We selected and reviewed reports describing the methods and results of adaptation of guidelines from those found by searching Medline, Internet, and reference lists of relevant papers. On the basis of this review and our experience in guideline development, we proposed a conceptual framework and procedure for adaptation of guidelines.
Adaptation of guidelines is performed either as an alternative to de novo guideline development or to improve guideline implementation through local tailoring of an international or national guideline. However, no validated process for the adaptation of guidelines produced in one cultural and organizational setting for use in another (i.e. trans-contextual adaptation) was found in the literature. The proposed procedure is a stepwise approach to trans-contextual adaptation, including searching for existing guidelines, quality appraisal, detailed analysis of the coherence between the evidence and the recommendations, and adaptation of the recommendations to the target context of use, taking into account the organization of the health care system and cultural context.
Trans-contextual adaptation of guidelines is increasingly being considered as an alternative to de novo guideline development. The proposed approach should be validated and evaluated to determine if it can reduce duplication of effort and inefficient use of resources, although guaranteeing a high-quality product, compared with de novo development.
高质量临床实践指南的制定和更新需要大量资源。世界各地的许多指南项目都在采用类似策略以实现类似目标，导致针对同一主题出现了众多指南。更高效利用资源并避免不必要的重复劳动的一种方法是改编现有指南。本研究旨在回顾关于指南改编的文献，并提出一种系统的指南改编方法。
我们从通过检索Medline、互联网以及相关论文的参考文献列表所找到的文献中，挑选并回顾了描述指南改编方法及结果的报告。基于这一回顾以及我们在指南制定方面的经验，我们提出了一个指南改编的概念框架和程序。
指南改编既可以作为从头制定指南的替代方式，也可以通过对国际或国家指南进行本地化调整来改善指南的实施。然而，文献中未发现针对在一种文化和组织环境中制定的指南在另一种环境中使用（即跨背景改编）的经过验证的流程。所提出的程序是一种跨背景改编的逐步方法，包括查找现有指南、质量评估、详细分析证据与推荐意见之间的一致性，以及根据目标使用背景对推荐意见进行调整，同时考虑医疗保健系统的组织和文化背景。
指南的跨背景改编越来越被视为从头制定指南的一种替代方式。尽管与从头制定相比要保证产品质量，但所提出的方法仍应进行验证和评估，以确定其是否能够减少重复劳动和资源的低效利用。
