Eknoyan G, Levin N W, Steinberg E
Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA.
Curr Opin Nephrol Hypertens. 1997 Nov;6(6):520-3. doi: 10.1097/00041552-199711000-00003.
Rigorously developed clinical practice guidelines have the potential to change practice patterns to obtain improved patient outcomes. Toward that end, in March 1995 the National Kidney Foundation initiated the Dialysis Outcomes Quality Initiative, a comprehensive effort to create literature-based clinical practice guidelines in nephrology. Independent interdisciplinary work groups reviewed the available body of scientific literature on the following topics: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access, and anemia. More than 11,000 papers were identified; of these approximately 1500 were found to be relevant, requiring formal structured review. Work groups formulated draft guidelines with supporting rationales that included the evidentiary basis for the recommendations. The draft guidelines were subjected to an unprecedented three-stage review process that involved more than 50 organizations from the renal community, including end-stage renal disease networks, patients dialysis providers, managed care organizations, and government. The finalized guidelines were issued in September 1997. Planned guideline implementation activities will focus on achieving the following: cooperation from the renal community; education of patients, clinicians, policy makers, and dialysis providers; information system tools to facilitate adoption of the guidelines; and evaluation strategies to determine whether practice patterns and outcome goals are achieved.
严格制定的临床实践指南有可能改变医疗行为模式，从而改善患者预后。为此，1995年3月美国国家肾脏基金会发起了“透析预后质量倡议”，这是一项全面的工作，旨在制定基于文献的肾脏病临床实践指南。独立的跨学科工作小组对以下主题的现有科学文献进行了审查：血液透析充分性、腹膜透析充分性、血管通路和贫血。共筛选出11000多篇论文，其中约1500篇被认为相关，需要进行正式的结构化审查。工作小组制定了带有支持理由的指南草案，这些理由包括建议的证据基础。该指南草案经历了前所未有的三阶段审查过程，参与审查的有来自肾脏领域的50多个组织，包括终末期肾病网络、患者、透析服务提供者、管理式医疗组织和政府部门。最终版指南于1997年9月发布。计划中的指南实施活动将集中于实现以下目标：肾脏领域的合作；对患者、临床医生、政策制定者和透析服务提供者的教育；便于采用指南的信息系统工具；以及确定是否实现了医疗行为模式和预后目标的评估策略。
