Codish Shlomi, Shiffman Richard N
Center for Medical Informatics,Yale School of Medicine, New Haven, CT, USA.
AMIA Annu Symp Proc. 2005;2005:146-50.
Ambiguity and vagueness in clinical practice guidelines reduce the likelihood of clinician adherence. They lead to inconsistent interpretation and, in turn, to inappropriate practice variation and medical errors. Resolving ambiguity and vagueness is an essential step in the computerized implementation of clinical practice guidelines. Successful resolution of ambiguity and vagueness requires an understanding of their characteristics, yet ambiguity and vagueness have not been differentiated, classified and described in medical context. In this paper, we propose a tri-axial model to describe ambiguity and vagueness in clinical practice guidelines: differentiation of true ambiguity from vagueness, classification of ambiguity and vagueness, intentionality and components involved. Our goals in introducing this model are: (a) to provide guidance to guideline authors to enable them to reduce inadvertent use of ambiguous or vague language, (b) to improve transparency when vague language is used deliberately and (c) to create a framework for the development of tools to apply the model during authoring and implementation of clinical practice guidelines.
临床实践指南中的模糊性和不确定性会降低临床医生遵循指南的可能性。它们会导致解释不一致，进而导致不适当的实践差异和医疗差错。解决模糊性和不确定性是临床实践指南计算机化实施的关键一步。成功解决模糊性和不确定性需要了解它们的特征，然而在医学背景下，模糊性和不确定性尚未得到区分、分类和描述。在本文中，我们提出了一个三轴模型来描述临床实践指南中的模糊性和不确定性：区分真正的模糊性与不确定性、对模糊性和不确定性进行分类、意向性以及涉及的组成部分。我们引入这个模型的目标是：(a) 为指南作者提供指导，使其能够减少无意中使用模糊或不确定的语言；(b) 当故意使用模糊语言时提高透明度；(c) 创建一个框架，用于开发在临床实践指南的编写和实施过程中应用该模型的工具。
