Bunn Frances, Trivedi Daksha, Alderson Phil, Hamilton Laura, Martin Alice, Pinkney Emma, Iliffe Steve
Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK.
Centre for Clinical Practice, National Institute for Health and Care Excellence, Manchester, UK.
Health Technol Assess. 2015 Apr;19(28):1-99, v-vi. doi: 10.3310/hta19280.
The last few decades have seen a growing emphasis on evidence-informed decision-making in health care. Systematic reviews, such as those produced by Cochrane, have been a key component of this movement. The National Institute for Health Research (NIHR) Systematic Review Programme currently supports 20 Cochrane Review Groups (CRGs) in the UK and it is important that this funding represents value for money.
The overall aim was to identify the impacts and likely impacts on health care, patient outcomes and value for money of Cochrane Reviews published by 20 NIHR-funded CRGs during the years 2007-11.
We sent questionnaires to CRGs and review authors, undertook interviews with guideline developers (GDs) 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. The evaluation was guided by a framework with four categories (knowledge production, research targeting, informing policy development and impact on practice/services).
A total of 3187 new and updated reviews were published on the Cochrane Database of Systematic Reviews between 2007 and 2011, 1502 (47%) of which were produced by the 20 CRGs funded by the NIHR. We found 40 examples where reviews appeared to have influenced primary research and reviews had contributed to the creation of new knowledge and stimulated debate. Twenty-seven of the 60 reviews had 100 or more citations in Google Scholar™ (Google, CA, USA). Overall, 483 systematic reviews had been cited in 247 sets of guidance. This included 62 sets of international guidance, 175 sets of national guidance (87 from the UK) and 10 examples of local guidance. Evidence from the interviews suggested that Cochrane Reviews often play an instrumental role in informing guidance, although reviews being a poor fit with guideline scope or methods, reviews being out of date and a lack of communication between CRGs and GDs were barriers to their use. Cochrane Reviews appeared to have led to a number of benefits to the health service including safer or more appropriate use of medication or other health technologies or the identification of new effective drugs or treatments. However, whether or not these changes were directly as a result of the Cochrane Review and not the result of subsequent clinical guidance was difficult to judge. Potential benefits of Cochrane Reviews included economic benefits through budget savings or the release of funds, improvements in clinical quality, the reduction in the use of unproven or unnecessary procedures and improvements in patient and carer experiences.
This study identified a number of impacts and likely impacts of Cochrane Reviews. The clearest impacts of Cochrane Reviews are on research targeting and health-care policy, with less evidence of a direct impact on clinical practice and the organisation and delivery of NHS services. Although it is important for researchers to consider how they might increase the influence of their work, such impacts are difficult to measure. More work is required to develop suitable methods for defining and quantifying the impact of research.
The NIHR Health Technology Assessment programme.
在过去几十年里，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）系统评价项目目前为英国的20个Cochrane评价小组（CRG）提供支持，确保这笔资金物有所值非常重要。
总体目标是确定20个由NIHR资助的CRG在2007年至2011年期间发表的Cochrane系统评价对医疗保健、患者结局和资金价值的影响及可能产生的影响。
我们向CRG和评价作者发送了问卷，对指南制定者（GD）进行了访谈，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系统评价样本的影响。该评价以一个包含四个类别的框架为指导（知识生产、研究目标设定、为政策制定提供信息以及对实践/服务的影响）。
2007年至2011年期间，Cochrane系统评价数据库共发表了3187篇新的和更新的评价，其中1502篇（47%）由NIHR资助的20个CRG完成。我们发现有40个例子表明评价似乎影响了原始研究，并且这些评价有助于新知识的产生并激发了讨论。60篇评价中有27篇在谷歌学术（Google，美国加利福尼亚州）上被引用100次或更多。总体而言，247套指南中引用了483篇系统评价。这包括62套国际指南、175套国家指南（87套来自英国）以及10个地方指南的例子。访谈证据表明，Cochrane系统评价在为指南提供信息方面通常发挥着重要作用，尽管评价与指南范围或方法不匹配、评价过时以及CRG和GD之间缺乏沟通是其应用的障碍。Cochrane系统评价似乎为卫生服务带来了一些益处，包括更安全或更合理地使用药物或其他卫生技术，或者识别出新的有效药物或治疗方法。然而，这些变化是否直接归因于Cochrane系统评价而非后续临床指南的结果很难判断。Cochrane系统评价的潜在益处包括通过节省预算或释放资金带来的经济效益、临床质量的提高、减少未经验证或不必要程序的使用以及改善患者和护理人员的体验。
本研究确定了Cochrane系统评价的一些影响及可能产生的影响。Cochrane系统评价最明显的影响在于研究目标设定和医疗保健政策，而对临床实践以及NHS服务的组织和提供的直接影响证据较少。尽管研究人员考虑如何增加其工作的影响力很重要，但此类影响难以衡量。需要开展更多工作来开发合适的方法，以界定和量化研究的影响。
NIHR卫生技术评估项目。
