Can China Master the Guideline Challenge?△_Chinese Journal of Evidence-Based Medicine

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10.7507/1672-2531.20130108

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中国的卫生保健费用日益增加，但缺乏对卫生保健质量和经费支出的严格监控。基于现有最佳证据，以患者为中心的指南有助于提高卫生保健质量和促进从证据到实践的转化。本文阐述了指南如何推动中国医疗卫生体制改革（简称“医改”），并特别总结了目前指南制定的现状及相关挑战，同时结合中国医改大背景，对可能的解决方案进行了初步探索。中国目前尚缺乏由某个专门的权威机构来制定和传播循证指南的能力。大多数指南使用者信赖专家小组制定的推荐意见，但这些推荐意见缺乏透明性（包括利益冲突的处理过程及证据检索、评价与合成过程的透明性），质量也无法保证。此外，人们对指南的作用存在认识误区，认为指南的作用只是为临床工作者提供决策信息而非必须遵守的准则；另外也有观点认为无法制定传统中医药的循证指南。所以，如果能够建立一个为指南制定提供或整合所有证据、指导指南制定工作及评价指南的核心机构，并与国际相关组织合作，不仅可以加强中国循证指南的制定能力，而且能够应对循证指南制定面临的挑战。

Citation： 杨克虎,陈耀龙,李幼平,Holger J Schnemann,代表兰州国际临床实践指南研讨会成员. Can China Master the Guideline Challenge?△. Chinese Journal of Evidence-Based Medicine, 2013, 13(6): 621-623. doi: 10.7507/1672-2531.20130108 Copy

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2.	Yip WC-M, Hsiao WC, Chen W, et al. Early appraisal of China’s huge and complex health-care reforms. Lancet, 2012, 379: 833-842.
3.	Lumbiganon P, Laopaiboon M, Gulmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007 – 08. Lancet, 2010, 375: 490- 499.
4.	Global Programme on Evidence for Health Policy: Guidelines for WHO guidelines. EIP/GPE/EQC/2003.1. Geneva: World Health Organization; 2003.
5.	Oxman AD, Fretheim A, Schunemann HJ. Improving the use of research evidence in guideline development: introduction. Health Res Policy Syst, 2006, 4: 12.
6.	IOM (Institute-of-Medicine). Clinical practice guidelines We Can trust. Washington, DC: The National Academies Press; 2011.
7.	Schunemann HJ, Woodhead M, Anzueto A, et al. A guide for guidelines for professional societies and other developers of recommendations: an official American Thoracic society (ATS)/European Respiratory Society (ERS) Workshop Report. Proc Am Thorac Soc, in press.
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12.	Schunemann HJ, Woodhead M, Anzueto A, et al. A vision statement on guideline development for respiratory disease: the example of COPD. Lancet, 2009, 373: 774-779.
13.	AGREE Next Steps Consortium (2009): The AGREE II Instrument [Electronic version] AJ; 2012. at http://www.agreetrust.org.

1. Meng Q, Xu L, Zhang Y, et al. Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study. Lancet, 2012, 379: 805-814.
2. Yip WC-M, Hsiao WC, Chen W, et al. Early appraisal of China’s huge and complex health-care reforms. Lancet, 2012, 379: 833-842.
3. Lumbiganon P, Laopaiboon M, Gulmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007 – 08. Lancet, 2010, 375: 490- 499.
4. Global Programme on Evidence for Health Policy: Guidelines for WHO guidelines. EIP/GPE/EQC/2003.1. Geneva: World Health Organization; 2003.
5. Oxman AD, Fretheim A, Schunemann HJ. Improving the use of research evidence in guideline development: introduction. Health Res Policy Syst, 2006, 4: 12.
6. IOM (Institute-of-Medicine). Clinical practice guidelines We Can trust. Washington, DC: The National Academies Press; 2011.
7. Schunemann HJ, Woodhead M, Anzueto A, et al. A guide for guidelines for professional societies and other developers of recommendations: an official American Thoracic society (ATS)/European Respiratory Society (ERS) Workshop Report. Proc Am Thorac Soc, in press.
8. Alonso-Coello P, Irfan A, Sola I, et al. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care, 2010, 19: e58.
9. Chen YL, Yao L, Xiao XJ, et al. Quality assessment of clinical guidelines in China: 1993 – 2010. Chin Med J, 2012, 125(20): 3660-3664.
10. Peking University Health Science Center: http://www.nhei.cn/export/sites/nhei/ennheis/wn/news/news_0009.html.
11. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336: 924–926.
12. Schunemann HJ, Woodhead M, Anzueto A, et al. A vision statement on guideline development for respiratory disease: the example of COPD. Lancet, 2009, 373: 774-779.
13. AGREE Next Steps Consortium (2009): The AGREE II Instrument [Electronic version] AJ; 2012. at http://www.agreetrust.org.

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