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德国循证卫生政策:学术界与卫生部门之间缺乏沟通与协调?

Evidence-based health policy in Germany: lack of communication and coordination between academia and health authorities?

机构信息

Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.

Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.

出版信息

Syst Rev. 2023 Mar 13;12(1):36. doi: 10.1186/s13643-023-02204-6.

Abstract

Health-care decision making should consider the best available evidence, often in the form of systematic reviews (SRs). The number of existing SRs and their overlap make their identification and use difficult. Decision makers often rely on de novo SRs instead of using existing SRs. We describe two cases of duplicate reviews (minimum volume threshold of total knee arthroplasties and lung cancer screening) and one case of duplicate primary data analysis (transcatheter aortic valve implantation). All cases have in common that unintended duplication of research occurred between health authorities and academia, demonstrating a lack of communication and coordination between them.It is important to note that academia and health authorities have different incentives. Academics are often measured by the number of peer-reviewed publications and grants awarded. In contrast, health authorities must comply with laws and are commissioned to deliver a specific report within a defined period of time. Most replication is currently unintended. A solution may be the collaboration of stakeholders commonly referred to as integrated knowledge translation (IKT). The IKT approach means that research is conducted in collaboration with the end users of the research. It requires active collaborations between researchers and decision-makers or knowledge users (clinicians, managers, policy makers) throughout the research process. Wherever cooperation is possible in spite of requirements for independence or confidentiality, legal regulations should facilitate and support collaborative approaches between academia and health authorities.

摘要

医疗决策应该考虑最佳可用证据,通常以系统评价(SR)的形式呈现。现有的 SR 数量及其重叠使得它们的识别和使用变得困难。决策者通常依赖新的 SR,而不是使用现有的 SR。我们描述了三个重复研究的案例(全膝关节置换术最小体积阈值和肺癌筛查)和一个重复原始数据分析的案例(经导管主动脉瓣植入术)。所有这些案例都有一个共同点,即在卫生当局和学术界之间发生了意外的重复研究,这表明它们之间缺乏沟通和协调。值得注意的是,学术界和卫生当局的激励措施不同。学术界通常通过同行评审出版物的数量和授予的资助来衡量。相比之下,卫生当局必须遵守法律,并在规定的时间内委托完成特定的报告。目前大多数复制都是无意的。解决方案可能是利益相关者的合作,通常称为综合知识转化(IKT)。IKT 方法意味着研究是与研究的最终用户合作进行的。它需要研究人员和决策者或知识使用者(临床医生、管理人员、政策制定者)在整个研究过程中进行积极的合作。只要在独立性或保密性的要求下有可能进行合作,法律规定就应该促进和支持学术界和卫生当局之间的合作方法。

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