Murad M Hassan
Division of Preventive Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2017 Mar;92(3):423-433. doi: 10.1016/j.mayocp.2017.01.001.
Trustworthy clinical practice guidelines should be based on a systematic review of the literature, provide ratings of the quality of evidence and the strength of recommendations, consider patient values, and be developed by a multidisciplinary panel of experts. The quality of evidence reflects our certainty that the evidence warrants a particular action. Transforming evidence into a decision requires consideration of the quality of evidence, balance of benefits and harms, patients' values, available resources, feasibility of the intervention, acceptability by stakeholders, and effect on health equity. Empirical evidence shows that adherence to guidelines improves patient outcomes; however, adherence to guidelines is variable. Therefore, guidelines require active dissemination and innovative implementation strategies.
值得信赖的临床实践指南应基于对文献的系统回顾，提供证据质量和推荐强度的评级，考虑患者价值观，并由多学科专家小组制定。证据质量反映了我们对证据支持特定行动的确定性。将证据转化为决策需要考虑证据质量、利弊平衡、患者价值观、可用资源、干预措施的可行性、利益相关者的可接受性以及对健康公平性的影响。实证证据表明，遵循指南可改善患者结局；然而，对指南的遵循情况存在差异。因此，指南需要积极传播和创新的实施策略。
