Bauchner H, Simpson L
Division of General Pediatrics, Boston University School of Medicine, MA 02118, USA.
Health Serv Res. 1998 Oct;33(4 Pt 2):1161-77.
To describe ways in which medical information should be developed and disseminated, focusing on pediatric practice guidelines as an example of one type of information.
The methodology of guideline development is well known and has been previously reviewed. Guideline development poses problems for many medical specialties, but particularly for pediatrics, because (1) few diseases are prevalent, (2) only limited randomized controlled trials have been conducted with respect to specific diagnostic and therapeutic options, and (3) clinicians often are dealing with patient surrogates--parents--rather than with the actual patient. Patient and family involvement in guideline development and dissemination has been limited and may affect the likelihood that guidelines will be adopted and subsequently improve child health outcomes. The science of dissemination, including guidelines and other information, is poorly developed. Little is known about the most effective ways to ensure that guidelines reach clinicians and are adopted. Finally, the effect of guidelines on child health outcomes is itself uncertain.
(1) Research efforts should focus on guideline dissemination and adoption. (2) The effect of guideline implementation on health outcomes needs to be better understood. (3) Parents should be more involved in guideline dissemination and adoption.
描述医学信息的开发与传播方式，以儿科实践指南为例阐述其中一类信息。
指南制定方法广为人知且此前已有相关综述。指南制定给许多医学专科带来问题，尤其是儿科，原因如下：（1）常见疾病较少；（2）针对特定诊断和治疗方案开展的随机对照试验有限；（3）临床医生常常面对的是患者代理人——父母，而非实际患者。患者及家庭在指南制定和传播过程中的参与有限，这可能影响指南被采用的可能性，进而影响改善儿童健康结局的效果。包括指南及其他信息在内的传播科学发展不足。对于确保指南能送达临床医生并被采用的最有效方式，人们了解甚少。最后，指南对儿童健康结局的影响本身也不确定。
（1）研究工作应聚焦于指南的传播与采用。（2）需要更好地理解指南实施对健康结局的影响。（3）父母应更多地参与指南的传播与采用。
