Haynes R B
Health Information Research Unit, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada.
Ann N Y Acad Sci. 1993 Dec 31;703:210-24; discussion 224-5. doi: 10.1111/j.1749-6632.1993.tb26350.x.
There is a considerable gap between sound evidence concerning health care interventions and the services that patients actually receive as health care. Practitioners and the health care system must overcome a number of barriers to narrow the gap. Viewed simplistically, there are three steps from evidence to practice: getting the evidence straight; developing clinical practice guidelines that are faithful to both the evidence and the clinical and personal situations of patients; and applying these guidelines to the right patient at the right time in the right way. Special problems in getting the evidence straight stem from difficulties in finding sound evidence. Lack of agreement on evidence standards undermine the effectiveness of authoritative practice guidelines. Applying evidence and practice guidelines effectively and efficiently is often thwarted by mismatches between evidence and usual practice circumstances. Time pressures undermine interpretation and application of evidence at every step. Understanding these problems may permit development of more effective strategies to bridge the gap between evidence and practice.
关于医疗保健干预措施的可靠证据与患者实际接受的医疗服务之间存在相当大的差距。从业者和医疗保健系统必须克服一些障碍来缩小这一差距。简单来看，从证据到实践有三个步骤：准确获取证据；制定忠实于证据以及患者临床和个人情况的临床实践指南；并以正确的方式在正确的时间将这些指南应用于合适的患者。准确获取证据方面的特殊问题源于难以找到可靠证据。证据标准缺乏一致性削弱了权威性实践指南的有效性。证据与通常的实践情况不匹配常常阻碍了有效且高效地应用证据和实践指南。时间压力在每一步都破坏了对证据的解读和应用。理解这些问题可能有助于制定更有效的策略来弥合证据与实践之间的差距。
