Wang Zijun, Wang Ling, Wang Bingyi, He Hongfeng, Li Zhewei, Zhu Di, Zhang Jie, Zhang Huayu, Chen Yaolong, Estill Janne
Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
Key Laboratory of Evidence Based Medicine of Gansu Province, Lanzhou, China.
JMIR Res Protoc. 2025 Aug 14;14:e63339. doi: 10.2196/63339.
The burden of multimorbidity is increasing globally, which complicates the use of guidelines in clinical practice and health care: practitioners may need to increasingly refer to multiple guidelines with potentially conflicting recommendations.
We aim to develop a guideline-based decision support framework for the management of patients with multimorbidity to help clinicians efficiently evaluate, select, and adapt recommendations focusing on the different comorbidities and aspects of multimorbidity.
We will conduct the project using the following steps: (1) needs assessment (searching published literature and documents on guideline use in multimorbidity care through the study initiators, and assessing the necessity of developing a comprehensive decision-making framework focusing on multimorbidity in a broad sense), (2) establishing international working groups (a coordination team, an evidence support group, and a consensus group) by leveraging existing participants' networks and inviting experts with relevant academic publications or activities, (3) conducting literature reviews of multimorbidity guidelines and original qualitative research involving interest-holders in multimorbidity care and/or guideline development to formulate an initial draft framework, (4) a consensus process including an expert survey and a consensus meeting, (5) formulating and releasing the final framework, and (6) testing the framework (collecting feedback through educating health professionals in different settings and applying the framework in practice to evaluate and improve it). We plan to complete the project within 3 years.
The project has started in March 2024 and is due to conclude in June 2026. As of May 2025, we have finished the literature reviews and qualitative studies and are currently conducting the first round of the expert survey.
This framework will help clinicians from all levels of health care institutions to make decisions in the management of patients with multimorbidity based on the latest available evidence, and to reduce potential health risks to their patients. One limitation of this framework is that such a broad framework may not fully fit all disease combinations or realistic situations. To reduce the degree of inapplicability, after completion of the framework, we will continue to monitor its use with regular updates as needed.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63339.
全球范围内，共病负担日益加重，这使得临床实践和医疗保健中指南的应用变得复杂：从业者可能需要越来越多地参考多个指南，而这些指南的建议可能相互冲突。
我们旨在开发一个基于指南的决策支持框架，用于管理共病患者，以帮助临床医生有效地评估、选择和调整针对不同共病及共病各方面的建议。
我们将按以下步骤开展该项目：（1）需求评估（通过研究发起者检索关于共病护理中指南应用的已发表文献和文件，并评估从广义上制定一个侧重于共病的综合决策框架的必要性），（2）利用现有参与者网络并邀请有相关学术出版物或活动的专家，组建国际工作组（一个协调团队、一个证据支持小组和一个共识小组），（3）对共病指南进行文献综述，并对涉及共病护理和/或指南制定的利益相关者进行原始定性研究，以制定初步框架草案，（4）包括专家调查和共识会议在内的共识过程，（5）制定并发布最终框架，（6）测试框架（通过在不同环境中培训卫生专业人员收集反馈，并在实践中应用该框架进行评估和改进）。我们计划在3年内完成该项目。
该项目于2024年3月启动，预计于2026年6月结束。截至2025年5月，我们已完成文献综述和定性研究，目前正在进行第一轮专家调查。
该框架将帮助各级医疗机构的临床医生基于最新可得证据对共病患者进行管理决策，并降低患者潜在的健康风险。该框架的一个局限性是，如此宽泛的框架可能无法完全适用于所有疾病组合或实际情况。为降低不适用性程度，在框架完成后，我们将继续根据需要定期更新来监测其使用情况。
国际注册报告识别号（IRRID）：DERR1-10.2196/63339
