Department of Otolaryngology, State University of New York Downstate, Medical Center, Brooklyn, New York 11201, USA.
Otolaryngol Head Neck Surg. 2013 Jan;148(1 Suppl):S1-55. doi: 10.1177/0194599812467004.
Guidelines translate best evidence into best practice. A well-crafted guideline promotes quality by reducing health care variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective-or potentially harmful-interventions. Despite a plethora of published guidelines, methodology is often poorly defined and varies greatly within and among organizations.
The third edition of this manual describes the principles and practices used successfully by the American Academy of Otolaryngology--Head and Neck Surgery Foundation to produce quality-driven, evidence-based guidelines using efficient and transparent methodology for actionable recommendations with multidisciplinary applicability. The development process emphasizes a logical sequence of key action statements supported by amplifying text, action statement profiles, and recommendation grades linking action to evidence. New material in this edition includes standards for trustworthy guidelines, updated classification of evidence levels, increased patient and public involvement, assessing confidence in the evidence, documenting differences of opinion, expanded discussion of conflict of interest, and use of computerized decision support for crafting actionable recommendations.
As clinical practice guidelines become more prominent as a key metric of quality health care, organizations must develop efficient production strategies that balance rigor and pragmatism. Equally important, clinicians must become savvy in understanding what guidelines are--and are not--and how they are best used to improve care. The information in this manual should help clinicians and organizations achieve these goals.
指南将最佳证据转化为最佳实践。精心制定的指南通过减少医疗保健差异、提高诊断准确性、促进有效治疗和避免无效或潜在有害的干预来提高质量。尽管有大量已发布的指南，但方法通常定义不明确，并且在组织内部和组织之间差异很大。
本手册第三版描述了美国耳鼻喉科学会-头颈外科学基金会成功使用的原则和实践，使用高效透明的方法为具有多学科适用性的可操作建议制定优质、基于证据的指南。开发过程强调了关键行动陈述的逻辑顺序，这些陈述得到了放大文本、行动陈述简介和将行动与证据联系起来的推荐等级的支持。本版新增内容包括值得信赖的指南标准、更新的证据水平分类、增加患者和公众参与、评估证据信心、记录意见分歧、扩大讨论利益冲突以及使用计算机化决策支持来制定可操作建议。
随着临床实践指南作为衡量医疗质量的重要指标变得越来越突出，组织必须制定平衡严谨性和实用性的高效生产策略。同样重要的是，临床医生必须熟悉指南是什么——以及不是什么——以及如何最好地使用它们来改善护理。本手册中的信息应有助于临床医生和组织实现这些目标。
