Woolf S H, DiGuiseppi C G, Atkins D, Kamerow D B
Department of Family Practice, Medical College of Virginia, Fairfax 22033, USA.
Annu Rev Public Health. 1996;17:511-38. doi: 10.1146/annurev.pu.17.050196.002455.
The US Preventive Services Task Force is an expert panel established by the federal government in 1984 to develop evidence-based practice guidelines on screening tests and other preventive services. Its recommendations are published elsewhere. This article explores the lessons learned in the process of developing and disseminating the recommendations. Topics include project organization (analytic philosophy, project sponsorship, panel composition, topic selection); the review of evidence (selecting outcome measures for judging effectiveness, constructing "causal pathways," searching the literature, rating the evidence, synthesizing the results); crafting recommendations (extrapolation, assessing magnitude, balancing risks and benefits, addressing costs, dealing with insufficient data, separating science from policy); peer review; collaboration with other groups; evaluating impact on clinicians' knowledge, attitudes, and behavior; updating recommendations; and defining a research agenda. The lessons learned suggest potential refinements in the future work of the task force and other groups engaged in guideline development.
美国预防服务工作组是一个由联邦政府于1984年设立的专家小组，旨在制定关于筛查测试和其他预防服务的循证实践指南。其建议在其他地方发表。本文探讨了在制定和传播这些建议的过程中吸取的经验教训。主题包括项目组织（分析理念、项目赞助、小组构成、主题选择）；证据审查（选择判断有效性的结果指标、构建“因果路径”、检索文献、评估证据、综合结果）；制定建议（外推法、评估程度、权衡风险和益处、处理成本、应对数据不足、区分科学与政策）；同行评审；与其他团体合作；评估对临床医生知识、态度及行为的影响；更新建议；以及确定研究议程。所吸取的经验教训为该工作组及其他从事指南制定工作的团体今后的工作提供了潜在的改进方向。
