Li Ka Shing Knowledge Institute (LKSKI) of St. Michael's Hospital, Knowledge Translation Program. 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8.
Li Ka Shing Knowledge Institute (LKSKI) of St. Michael's Hospital, Knowledge Translation Program. 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8; Keenan Research Centre of LKSKI of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8.
J Clin Epidemiol. 2015 May;68(5):498-509. doi: 10.1016/j.jclinepi.2014.12.013. Epub 2015 Jan 10.
To identify factors associated with the implementability of clinical practice guidelines (CPGs) and to determine what characteristics improve their uptake.
We conducted a realist review, which involved searching multiple sources (eg, databases, experts) to determine what about guideline implementability works, for whom, and under what circumstances. Two sets of reviewers independently screened abstracts and extracted data from 278 included studies. Analysis involved the development of a codebook of definitions, validation of data, and development of hierarchical narratives to explain guideline implementability.
We found that guideline implementability is associated with two broad goals in guideline development: (1) creation of guideline content, which involves addressing the domains of stakeholder involvement in CPGs, evidence synthesis, considered judgment (eg, clinical applicability), and implementation feasibility and (2) the effective communication of this content, which involves domains related to fine-tuning the CPG's message (using simple, clear, and persuasive language) and format.
Our work represents a comprehensive and interdisciplinary effort toward better understanding, which attributes of guidelines have the potential to improve uptake in clinical practice. We also created codebooks and narratives of key concepts, which can be used to create tools for developing better guidelines to promote better care.
确定与临床实践指南（CPG）实施性相关的因素，并确定哪些特征可提高其采用率。
我们进行了一项真实主义审查，其中包括从多个来源（例如数据库、专家）进行搜索，以确定指南实施性的哪些方面有效、针对谁有效以及在什么情况下有效。两组审查员独立筛选摘要并从 278 项纳入研究中提取数据。分析包括制定定义编码本、验证数据以及制定分层叙述以解释指南实施性。
我们发现指南实施性与指南制定中的两个广泛目标相关：（1）创建指南内容，其中涉及解决利益相关者参与 CPG、证据综合、审慎判断（如临床适用性）以及实施可行性等领域；（2）有效传达此内容，其中涉及与微调 CPG 信息相关的领域（使用简单、清晰和有说服力的语言）和格式。
我们的工作代表了对更好理解的全面和跨学科努力，指南的哪些特征有可能提高在临床实践中的采用率。我们还创建了关键概念的编码本和叙述，可以用于创建开发更好指南的工具，以促进更好的护理。
