Clyne Barbara, Tyner Barrie, O'Neill Michelle, Jordan Karen, Carty Paul G, Phillips Mahdiye K, Power Karen, Turner Michael J, Smith Susan M, Ryan Mairin
Health Research Board - Collaboration in Ireland for Clinical Effectiveness Reviews (HRB-CICER), Health Information and Quality Authority, Cork and Dublin, Ireland; Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
Health Research Board - Collaboration in Ireland for Clinical Effectiveness Reviews (HRB-CICER), Health Information and Quality Authority, Cork and Dublin, Ireland.
J Clin Epidemiol. 2022 Jul;147:21-31. doi: 10.1016/j.jclinepi.2022.03.005. Epub 2022 Mar 18.
Adaptation has been proposed as an alternative to de novo development to take advantage of existing clinical guidelines (guidelines) and reduce duplication. We describe the process of incorporating a modified Delphi method to reach formal consensus and inform locally relevant clinical recommendations during the development, through the ADAPTE process, of the Irish National Clinical Guideline No. 23 Stratification of Clinical Risk in Pregnancy.
A systematic search of guideline repositories, websites, and bibliographic databases was conducted. Quality appraisal was undertaken using AGREE II. Risk factors indicating the need for additional care were identified and extracted from high-quality guidelines. A three-round modified Delphi panel comprising healthcare stakeholders, was convened to agree and tailor risk factors.
Of seven relevant international guidelines identified, three were considered high quality and contained a combined 59 risk factors potentially suitable for adaptation. Following the three-round Delphi process, 49 risk factors were included in the final guideline. Excluded risk factors were generally considered to be too broad to be useful for the Irish context.
We believe that a formal consensus technique included within the ADAPTE process increased the rigor and transparency of this process and ensured the inclusion of more locally relevant risk factors.
有人提出采用改编的方式替代从头开发，以利用现有的临床指南并减少重复工作。我们描述了在通过ADAPTE流程制定爱尔兰国家临床指南第23号《妊娠临床风险分层》的过程中，纳入改良德尔菲法以达成正式共识并形成当地相关临床建议的过程。
对指南库、网站和书目数据库进行了系统检索。使用AGREE II进行质量评估。从高质量指南中识别并提取表明需要额外护理的风险因素。召集了一个由医疗保健利益相关者组成的三轮改良德尔菲小组，以商定并调整风险因素。
在确定的七项相关国际指南中，三项被认为质量较高，共包含59个可能适合改编的风险因素。经过三轮德尔菲法后，最终指南纳入了49个风险因素。被排除的风险因素通常被认为过于宽泛，对爱尔兰的情况没有用处。
我们认为，ADAPTE流程中包含的正式共识技术提高了该过程的严谨性和透明度，并确保纳入了更多与当地相关的风险因素。
