Siering Ulrich, Eikermann Michaela, Hausner Elke, Hoffmann-Eßer Wiebke, Neugebauer Edmund A
Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
Institute for Research in Operative Medicine (IFOM), Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany.
PLoS One. 2013 Dec 9;8(12):e82915. doi: 10.1371/journal.pone.0082915. eCollection 2013.
Clinical practice guidelines can improve healthcare processes and patient outcomes, but are often of low quality. Guideline appraisal tools aim to help potential guideline users in assessing guideline quality. We conducted a systematic review of publications describing guideline appraisal tools in order to identify and compare existing tools.
Among others we searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from 1995 to May 2011 for relevant primary and secondary publications. We also handsearched the reference lists of relevant publications. On the basis of the available literature we firstly generated 34 items to be used in the comparison of appraisal tools and grouped them into thirteen quality dimensions. We then extracted formal characteristics as well as questions and statements of the appraisal tools and assigned them to the items.
We identified 40 different appraisal tools. They covered between three and thirteen of the thirteen possible quality dimensions and between three and 29 of the possible 34 items. The main focus of the appraisal tools were the quality dimensions "evaluation of evidence" (mentioned in 35 tools; 88%), "presentation of guideline content" (34 tools; 85%), "transferability" (33 tools; 83%), "independence" (32 tools; 80%), "scope" (30 tools; 75%), and "information retrieval" (29 tools; 73%). The quality dimensions "consideration of different perspectives" and "dissemination, implementation and evaluation of the guideline" were covered by only twenty (50%) and eighteen tools (45%) respectively.
Most guideline appraisal tools assess whether the literature search and the evaluation, synthesis and presentation of the evidence in guidelines follow the principles of evidence-based medicine. Although conflicts of interest and norms and values of guideline developers, as well as patient involvement, affect the trustworthiness of guidelines, they are currently insufficiently considered. Greater focus should be placed on these issues in the further development of guideline appraisal tools.
临床实践指南能够改善医疗过程和患者预后，但质量往往不高。指南评估工具旨在帮助潜在的指南使用者评估指南质量。我们对描述指南评估工具的出版物进行了系统评价，以识别和比较现有工具。
除其他外，我们检索了1995年至2011年5月期间的MEDLINE、EMBASE和Cochrane系统评价数据库，以查找相关的一级和二级出版物。我们还手工检索了相关出版物的参考文献列表。根据现有文献，我们首先生成了34项用于评估工具比较的条目，并将它们分为13个质量维度。然后，我们提取了评估工具的形式特征以及问题和陈述，并将它们分配到各个条目。
我们识别出40种不同的评估工具。它们涵盖了13个可能的质量维度中的3至13个，以及34个可能条目中的3至29个。评估工具的主要重点是质量维度“证据评估”（35种工具提及；88%）、“指南内容呈现”（34种工具；85%）、“可转移性”（33种工具；83%）、“独立性”（32种工具；80%）、“范围”（30种工具；75%）和“信息检索”（29种工具；73%）。质量维度“考虑不同观点”和“指南的传播、实施和评估”分别仅被20种工具（50%）和18种工具（45%）涵盖。
大多数指南评估工具评估指南中的文献检索以及证据的评估、综合和呈现是否遵循循证医学原则。尽管利益冲突、指南制定者的规范和价值观以及患者参与会影响指南的可信度，但目前对这些方面的考虑尚不充分。在指南评估工具的进一步开发中，应更加关注这些问题。
