Department of Clinical Pharmacy, Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, USA.
J Clin Epidemiol. 2013 Feb;66(2):132-9. doi: 10.1016/j.jclinepi.2012.07.007. Epub 2012 Sep 10.
Clinical practice guidelines are one of the tools available to improve the quality of health care. However, it may be difficult for countries to develop their own national guidelines "from scratch" because of limitations in time, expertise, and financial resources. The Estonian Health Insurance Fund (EHIF), in collaboration with other stakeholders, has launched a national effort to develop and implement evidence-based clinical practice guidelines aimed at improving the quality of care. Although the first EHIF handbook for preparing guidelines was published in 2004, there has been wide variation in the format and quality of guidelines prepared by medical specialty societies, EHIF, and other organizations in Estonia. An additional challenge to guideline development in Estonia is that it is a country with limited human resources. Therefore, revision of the Estonian guideline process was aimed at developing an efficient method for adapting current high-quality guidelines to the Estonian setting without compromising their quality. In 2010, a comprehensive assessment of guideline development in Estonia was made by the World Health Organization, EHIF, the Medical Faculty at the University of Tartu, and selected national and international experts in an effort to streamline and harmonize the principles and processes of guideline development in Estonia. This study summarizes the evaluation of and revisions to the process. Estonia has made substantial changes in its processes of clinical practice guideline development and implementation as part of an overall program aiming for systematic quality improvement in health care. This experience may be relevant to other small or resource-limited countries.
临床实践指南是提高医疗质量的工具之一。然而，由于时间、专业知识和财力资源的限制，各国可能难以从零开始制定自己的国家指南。爱沙尼亚健康保险基金（EHIF）与其他利益相关者合作，开展了一项制定和实施循证临床实践指南的国家努力，旨在提高护理质量。尽管 2004 年出版了第一本 EHIF 指南编写手册，但医学专业协会、EHIF 和爱沙尼亚其他组织编写的指南在格式和质量上存在很大差异。爱沙尼亚指南制定的另一个挑战是，该国人力资源有限。因此，爱沙尼亚指南修订的目的是开发一种有效的方法，在不影响其质量的前提下，将当前高质量的指南适应当地情况。2010 年，世界卫生组织、EHIF、塔尔图大学医学院以及选定的国家和国际专家对爱沙尼亚的指南制定情况进行了全面评估，努力简化和协调爱沙尼亚指南制定的原则和程序。本研究总结了对该过程的评估和修订。爱沙尼亚在其临床实践指南制定和实施过程中进行了重大改革，作为旨在实现医疗保健系统质量改进的总体计划的一部分。这一经验可能与其他小国或资源有限的国家有关。
