Goetghebeur Mireille M, Wagner Monika, Khoury Hanane, Levitt Randy J, Erickson Lonny J, Rindress Donna
BioMedCom Consultants Inc, 1405 Transcanada Highway, Suite 310, Dorval, Québec H9P 2V9, Canada.
BMC Health Serv Res. 2008 Dec 22;8:270. doi: 10.1186/1472-6963-8-270.
Healthcare decisionmaking is a complex process relying on disparate types of evidence and value judgments. Our objectives for this study were to develop a practical framework to facilitate decisionmaking in terms of supporting the deliberative process, providing access to evidence, and enhancing the communication of decisions.
Extensive analyses of the literature and of documented decisionmaking processes around the globe were performed to explore what steps are currently used to make decisions with respect to context (from evidence generation to communication of decision) and thought process (conceptual components of decisions). Needs and methodologies available to support decisionmaking were identified to lay the groundwork for the EVIDEM framework.
A framework was developed consisting of seven modules that can evolve over the life cycle of a healthcare intervention. Components of decision that could be quantified, i.e., intrinsic value of a healthcare intervention and quality of evidence available, were organized into matrices. A multicriteria decision analysis (MCDA) Value Matrix (VM) was developed to include the 15 quantifiable components that are currently considered in decisionmaking. A methodology to synthesize the evidence needed for each component of the VM was developed including electronic access to full text source documents. A Quality Matrix was designed to quantify three criteria of quality for the 12 types of evidence usually required by decisionmakers. An integrated system was developed to optimize data analysis, synthesis and validation by experts, compatible with a collaborative structure.
The EVIDEM framework promotes transparent and efficient healthcare decisionmaking through systematic assessment and dissemination of the evidence and values on which decisions are based. It provides a collaborative framework that could connect all stakeholders and serve the healthcare community at local, national and international levels by allowing sharing of data, resources and values. Validation and further development is needed to explore the full potential of this approach.
医疗保健决策是一个复杂的过程，依赖于不同类型的证据和价值判断。本研究的目的是开发一个实用框架，以促进决策制定，包括支持审议过程、提供获取证据的途径以及加强决策沟通。
对全球范围内的文献和记录在案的决策过程进行了广泛分析，以探索目前在决策过程中针对背景（从证据生成到决策沟通）和思维过程（决策的概念组成部分）所采用的步骤。确定了支持决策的需求和可用方法，为EVIDEM框架奠定基础。
开发了一个由七个模块组成的框架，该框架可在医疗保健干预的生命周期内不断演变。可以量化的决策组成部分，即医疗保健干预的内在价值和可用证据的质量，被整理成矩阵。开发了多标准决策分析（MCDA）价值矩阵（VM），以纳入目前决策中考虑的15个可量化组成部分。开发了一种方法来综合VM每个组成部分所需的证据，包括通过电子方式获取全文源文件。设计了一个质量矩阵，以量化决策者通常所需的12种证据类型的三个质量标准。开发了一个集成系统，以优化专家进行的数据分析、综合和验证，该系统与协作结构兼容。
EVIDEM框架通过系统评估和传播决策所依据的证据和价值观，促进透明和高效的医疗保健决策。它提供了一个协作框架，可以连接所有利益相关者，并通过允许共享数据、资源和价值观，为地方、国家和国际层面的医疗保健社区服务。需要进行验证和进一步开发，以探索这种方法的全部潜力。
