Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Urology, University of Minnesota, Minneapolis, MN, USA.
J Clin Epidemiol. 2021 Oct;138:115-127. doi: 10.1016/j.jclinepi.2021.04.016. Epub 2021 May 13.
Stakeholders involved in developing recommendations need to have a common understanding of health outcomes and the perspective of affected individuals. In this paper we report on the development and application of health outcome descriptors (HODs) to inform decision-making by panels developing guideline recommendations.
Ten American Society of Hematology guideline panels addressing the management of venous thromboembolism developed HODs, rated their importance and health utility, applied them to prioritize outcomes, and to balance potential benefits and harms to formulate recommendations.
It was feasible to involve 18 panelists in developing 127 HODs. There was high agreement (82%) across the ten panels about outcomes perceived as critical or important for decision-making. Panelists' utility ratings of the outcomes were strongly correlated with panelists' outcome importance ratings (Pearson's r=-0.88). HODs were incorporated into Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence-to-decision (EtD) frameworks to support a shared understanding of health outcomes in panel deliberations.
HODs serve as a valuable tool to promote an explicit, common understanding of health outcomes during clinical guideline development and across different stakeholders. They are helpful across multiple steps of guideline development to facilitate panels' judgements, aiming to avoid variable implicit interpretations of health outcomes.
参与制定建议的利益相关者需要对健康结果和受影响个体的观点有共同的理解。本文报告了健康结果描述符（HOD）的制定和应用，以告知制定指南建议的小组做出决策。
十个美国血液学会指南小组针对静脉血栓栓塞症的管理制定了 HODs，对其重要性和健康效用进行了评分，将其应用于优先考虑结果，并平衡潜在的收益和危害，以制定建议。
让 18 名小组成员参与制定 127 个 HODs 是可行的。十个小组之间对于被认为对决策至关重要或重要的结果有很高的一致性（82%）。小组成员对结果的效用评分与他们对结果重要性的评分有很强的相关性（Pearson r=-0.88）。HODs 被纳入推荐评估、制定和评估（GRADE）证据决策（EtD）框架，以支持在小组审议中对健康结果有共同的理解。
HODs 是一种有价值的工具，可以在临床指南制定和不同利益相关者之间促进对健康结果的明确、共同理解。它们在指南制定的多个步骤中都很有帮助，有助于小组的判断，旨在避免对健康结果的不同隐含解释。
