Department of Medicine, Sykehuset Innlandet HF (Innlandet Hospital Trust), Gjøvik, Norway; The Norwegian Knowledge Centre for the Health Services, Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Medicine, Sykehuset Innlandet HF (Innlandet Hospital Trust), Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
Chest. 2013 Aug;144(2):381-389. doi: 10.1378/chest.13-0746.
Standards and guidance for developing trustworthy clinical practice guidelines are now available, and a number of leading guidelines adhere to the key standards. Even current trustworthy guidelines, however, generally suffer from a cumbersome development process, suboptimal presentation formats, inefficient dissemination to clinicians at the point of care, high risk of becoming quickly outdated, and suboptimal facilitation of shared decision-making with patients. To address these limitations, we have--in our innovative research program and nonprofit organization, MAGIC (Making GRADE the Irresistible Choice)--constructed a conceptual framework and tools to facilitate the creation, dissemination, and dynamic updating of trustworthy guidelines. We have developed an online application that constitutes an authoring and publication platform that allows guideline content to be written and structured in a database, published directly on our web platform or exported in a computer-interpretable language (eg, XML) enabling dissemination through a wide range of outputs that include electronic medical record systems, web portals, and applications for smartphones/tablets. Modifications in guidelines, such as recommendation updates, will lead to automatic alterations in these outputs with minimal additional labor for guideline authors and publishers, greatly facilitating dynamic updating of guidelines. Semiautomated creation of a new generation of decision aids linked to guideline recommendations should facilitate face-to-face shared decision-making in the clinical encounter. We invite guideline organizations to partner with us (www.magicproject.org) to apply and further improve the tools for their purposes. This work will result in clinical practice guidelines that we cannot only trust, but also easily share and use.
现在已经有了用于制定可靠临床实践指南的标准和指南,并且许多领先的指南都符合关键标准。然而,即使是目前可靠的指南,通常也存在繁琐的开发过程、不理想的呈现格式、在护理点向临床医生有效传播的效率低下、快速过时的高风险以及对与患者共同决策的支持不佳等问题。为了解决这些限制,我们在我们的创新研究计划和非营利组织 MAGIC(使 GRADE 成为不可抗拒的选择)中构建了一个概念框架和工具,以促进可靠指南的创建、传播和动态更新。我们开发了一个在线应用程序,构成了一个创作和发布平台,允许在数据库中编写和结构化指南内容,直接在我们的网络平台上发布或导出计算机可解释的语言(例如 XML),从而通过广泛的输出渠道进行传播,包括电子病历系统、Web 门户和智能手机/平板电脑应用程序。指南的修改,如推荐更新,将导致这些输出的自动更改,指南作者和发布者只需付出最小的额外劳动,从而大大方便了指南的动态更新。半自动创建与指南建议相关的新一代决策辅助工具应该有助于在临床就诊中进行面对面的共同决策。我们邀请指南组织与我们合作(www.magicproject.org),以应用和进一步改进这些工具以满足其需求。这项工作将产生我们不仅可以信任,而且还可以轻松共享和使用的临床实践指南。