Rehfuess Eva A, Stratil Jan M, Scheel Inger B, Portela Anayda, Norris Susan L, Baltussen Rob
Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany.
Department of Global Health, Norwegian Institute of Public Health, Oslo, Norway.
BMJ Glob Health. 2019 Jan 25;4(Suppl 1):e000844. doi: 10.1136/bmjgh-2018-000844. eCollection 2019.
Evidence-to-decision (EtD) frameworks intend to ensure that all criteria of relevance to a health decision are systematically considered. This paper, part of a series commissioned by the WHO, reports on the development of an EtD framework that is rooted in WHO norms and values, reflective of the changing global health landscape, and suitable for a range of interventions and complexity features. We also sought to assess the value of this framework to decision-makers at global and national levels, and to facilitate uptake through suggestions on how to prioritise criteria and methods to collect evidence.
In an iterative, principles-based approach, we developed the framework structure from WHO norms and values. Preliminary criteria were derived from key documents and supplemented with comprehensive subcriteria obtained through an overview of systematic reviews of criteria employed in health decision-making. We assessed to what extent the framework can accommodate features of complexity, and conducted key informant interviews among WHO guideline developers. Suggestions on methods were drawn from the literature and expert consultation.
The new WHO-INTEGRATE (INTEGRATe Evidence) framework comprises six substantive criteria-, , , , , , and -and the meta-criterion . It is intended to facilitate a structured process of reflection and discussion in a problem-specific and context-specific manner from the start of a guideline development or other health decision-making process. For each criterion, the framework offers a definition, subcriteria and example questions; it also suggests relevant primary research and evidence synthesis methods and approaches to assessing quality of evidence.
The framework is deliberately labelled version 1.0. We expect further modifications based on focus group discussions in four countries, example applications and input across concerned disciplines.
证据到决策（EtD）框架旨在确保与健康决策相关的所有标准都得到系统考虑。本文是世界卫生组织委托编写的系列文章的一部分，报告了一个基于世界卫生组织规范和价值观、反映全球卫生格局变化、适用于一系列干预措施和复杂特征的EtD框架的开发情况。我们还试图评估该框架对全球和国家层面决策者的价值，并通过就如何对标准进行优先排序以及收集证据的方法提出建议来促进其应用。
我们采用基于原则的迭代方法，从世界卫生组织的规范和价值观出发制定框架结构。初步标准源自关键文件，并通过对健康决策中使用的标准的系统评价概述补充了全面的子标准。我们评估了该框架在多大程度上能够适应复杂性特征，并在世卫组织指南制定者中进行了关键信息访谈。关于方法的建议来自文献和专家咨询。
新的世界卫生组织综合证据（WHO-INTEGRATE）框架包括六个实质性标准——[此处六个标准原文未给出具体内容]以及元标准[此处元标准原文未给出具体内容]。它旨在从指南制定或其他健康决策过程开始时，以针对具体问题和具体情况的方式促进结构化的反思和讨论过程。对于每个标准，该框架提供了定义、子标准和示例问题；还建议了相关的基础研究、证据综合方法以及评估证据质量的方法。
该框架特意标记为1.0版本。我们期望基于在四个国家进行的焦点小组讨论、示例应用以及相关学科的意见进行进一步修改。
