Dowie Jack, Kaltoft Mette Kjer
Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000 Odense C, Denmark.
Med Sci (Basel). 2018 Nov 29;6(4):109. doi: 10.3390/medsci6040109.
The launch of 'Rapid Recommendations' by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) group, in collaboration with Making GRADE the Irresistible Choice (MAGIC) and the British Medical Journal (BMJ), is a very interesting recent development in e-healthcare. Designed to respond quickly to developments that have created new decision situations, their first project resulted from the arrival of minimally invasive Transcatheter Aortic Valve Implantation (TAVI) as an alternative to Surgical Aortic Valve Replacement (SAVR), for patients with symptomatic severe aortic stenosis. The interactive MAGIC decision aid that accompanies a Rapid Recommendation and is the main route to its clinical implementation, represents a major advance in e-health, for a cardiovascular decision in this case. However, it needs to go further in order to facilitate fully person-centred care, where the weighted preferences of the individual person are elicited at the point of decision, and transparently integrated with the best (most personalised) estimates of option performances, to produce personalised, preference-sensitive option evaluations. This can be achieved by inputting the collated GRADE evidence on the criteria relevant in the TAVI/SAVR choice into a Multi-Criteria Decision Analysis-based decision support tool, generating a personalised, preference-sensitive opinion. A demonstration version of this add-on to the MAGIC aid, divested of recommendations, is available online as proof of method.
推荐分级评估、制定与评价（GRADE）小组与让GRADE成为不可抗拒的选择（MAGIC）及《英国医学杂志》（BMJ）合作推出的“快速推荐”，是电子医疗保健领域近期一项非常有趣的进展。其旨在迅速应对那些产生新决策情况的发展变化，首个项目源于微创经导管主动脉瓣植入术（TAVI）作为有症状严重主动脉瓣狭窄患者外科主动脉瓣置换术（SAVR）替代方案的出现。伴随快速推荐并作为其临床实施主要途径的交互式MAGIC决策辅助工具，就这种心血管决策而言，代表了电子医疗领域的一项重大进步。然而，它需要进一步发展，以促进完全以患者为中心的医疗，即在决策时引出个人的加权偏好，并将其与选项表现的最佳（最个性化）估计透明地整合起来，以产生个性化的、偏好敏感的选项评估。这可以通过将整理好的关于TAVI/SAVR选择相关标准的GRADE证据输入基于多标准决策分析的决策支持工具来实现，从而生成个性化的、偏好敏感的意见。作为方法验证，MAGIC辅助工具这个附加组件的一个演示版本已在线提供，其中没有推荐内容。
