Bunn Frances, Trivedi Daksha, Alderson Phil, Hamilton Laura, Martin Alice, Iliffe Steve
Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK.
Syst Rev. 2014 Oct 27;3:125. doi: 10.1186/2046-4053-3-125.
BACKGROUND: There has been a growing emphasis on evidence-informed decision-making in health care. Systematic reviews, such as those produced by the Cochrane Collaboration, have been a key component of this movement. The UK National Institute for Health Research (NIHR) Systematic Review Programme currently supports 20 Cochrane Review Groups (CRGs). The aim of this study was to identify the impacts of Cochrane reviews published by NIHR-funded CRGs during the years 2007-2011. METHODS: We sent questionnaires to CRGs and review authors, interviewed guideline developers and used bibliometrics and documentary review to get an overview of CRG impact and to evaluate the impact of a sample of 60 Cochrane reviews. We used a framework with four categories (knowledge production, research targeting, informing policy development and impact on practice/services). RESULTS: A total of 1,502 new and updated reviews were produced by the 20 NIHR-funded CRGs between 2007 and 2011. The clearest impacts were on policy with a total of 483 systematic reviews cited in 247 sets of guidance: 62 were international, 175 national (87 from the UK) and 10 local. Review authors and CRGs provided some examples of impact on practice or services, for example, safer use of medication, the identification of new effective drugs or treatments and potential economic benefits through the reduction in the use of unproven or unnecessary procedures. However, such impacts are difficult to objectively document, and the majority of reviewers were unsure if their review had produced specific impacts. Qualitative data suggested that Cochrane reviews often play an instrumental role in informing guidance, although a poor fit with guideline scope or methods, reviews being out of date and a lack of communication between CRGs and guideline developers were barriers to their use. CONCLUSIONS: Health and economic impacts of research are generally difficult to measure. We found that to be the case with this evaluation. Impacts on knowledge production and clinical guidance were easier to identify and substantiate than those on clinical practice. Questions remain about how we define and measure impact, and more work is needed to develop suitable methods for impact analysis.
背景：医疗保健领域越来越强调基于证据的决策。系统评价，如Cochrane协作网开展的那些评价，一直是这一行动的关键组成部分。英国国家卫生研究院（NIHR）系统评价项目目前支持20个Cochrane评价小组（CRGs）。本研究的目的是确定NIHR资助的CRGs在2007年至2011年期间发表的Cochrane评价的影响。 方法：我们向CRGs和评价作者发送了问卷，采访了指南制定者，并使用文献计量学和文献综述来全面了解CRG的影响，并评估60篇Cochrane评价样本的影响。我们使用了一个包含四个类别的框架（知识产出、研究目标、为政策制定提供信息以及对实践/服务的影响）。 结果：20个由NIHR资助的CRGs在2007年至2011年期间共产生了1502篇新的和更新的评价。最明显的影响是对政策方面，247套指南中总共引用了483篇系统评价：62篇是国际性的，175篇是国家级的（87篇来自英国），10篇是地方性的。评价作者和CRGs提供了一些对实践或服务有影响的例子，例如，更安全地使用药物、识别新的有效药物或治疗方法以及通过减少使用未经证实或不必要的程序获得潜在的经济效益。然而，这种影响难以客观记录，大多数评价者不确定他们的评价是否产生了具体影响。定性数据表明，Cochrane评价在为指南提供信息方面往往发挥着重要作用，尽管与指南范围或方法不匹配、评价过时以及CRGs与指南制定者之间缺乏沟通是其应用的障碍。 结论：研究对健康和经济的影响通常难以衡量。我们发现本次评估就是这种情况。对知识产出和临床指南的影响比临床实践方面的影响更容易识别和证实。关于如何定义和衡量影响仍存在问题，需要开展更多工作来开发合适的影响分析方法。
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