An investigation of the sources of evidence of the clinical pathways in China_Chinese Journal of Evidence-Based Medicine

Authors：

XUN Yangqin ^1,2,3 ^# , CHENG Peng ⁴ ^# , LI Xiuxia ^1,2,3 , WEI Dang ² , YAO Liang ⁵ , PAN Bei ¹ , YAN Peijing ⁶ , XU Ke ¹ , LI Yanan ^1,2,3 , GUO Tiankang ⁶ ,  YANG Kehu ^2,3

1. School of Public Health, Lanzhou University, Lanzhou, 730000, P.R.China;
2. Evidence-Based Medicine Center, Lanzhou University, Lanzhou, 730000, P.R.China;
3. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, P.R.China;
4. Department of Orthopedics, Second Hospital of Lanzhou University, Lanzhou, 730030, P.R.China;
5. Chinese Medicine Faculty of Hong Kong Baptist University, HongKong, 999077, P.R.China;
6. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;

Corresponding author：

YANG Kehu, Email: kehuyangebm2006@126.com

Keywords：

Clinical pathways; Evidence-based Medicine; Evidence

DOI：

10.7507/1672-2531.201801133

Video：

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ObjectivesTo investigate sources of evidence of the clinical pathways approved by the Chinese government.MethodsThe approved clinical pathways were obtained from the website of the National Health and Family Planning Commission. Two reviewers independently extracted the basic information, approval date, types of evidence of the clinical pathways and time of evidence. The variance analysis was performed for the diagnosis and treatment parts of clinical pathways and the LSD method was further used for comparison.ResultsThe main types of evidence were guidelines, textbooks, standard indicators and consensus views. Approximately 80% of the pathways cited clinical practice guidelines and 36% cited the textbooks. The median number of evidence for each clinical pathway was 2. Approximately 85% of the evidence could be obtained the time when the evidence published. The average time interval (between the time when the pathways released and the time when the evidence published) was 5.2 years. Specifically, textbooks constituted the largest proportion in all evidence that was over 15 years of time interval. In addition to the textbook comparison standard indicators, there were significant differences in time interval between guidelines or consensus and textbooks or standard indicators.Conclusions The evidence types selection is based on the concept of evidence-based medicine, yet the time span of the referred evidence is larger. Therefore, developing clinical pathways not only need to refer to the latest research evidence comprehensively and enhance transparency of clinical pathways, but also use evidence quality evaluation standards to evaluate and select the referred evidences.

Citation： XUN Yangqin, CHENG Peng, LI Xiuxia, WEI Dang, YAO Liang, PAN Bei, YAN Peijing, XU Ke, LI Yanan, GUO Tiankang, YANG Kehu. An investigation of the sources of evidence of the clinical pathways in China. Chinese Journal of Evidence-Based Medicine, 2018, 18(10): 1032-1036. doi: 10.7507/1672-2531.201801133 Copy

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1. Hassan IS. Knowledge translation through clinical pathways: principles for practical development and successful use. Saudi J Kidney Dis Transpl, 2013, 24(2): 351-363.
2. Mallock N. A template for clinical pathway design based on international evidence. Clinical Governance Bulletin, 2005, 5(5): 2-4.
3. Kinsman L, Rotter T, James E, et al. What is a clinical pathway? Development of a definition to inform the debate. BMC Med, 2010, 8: 31.
4. 李清华. 临床路径的现状和发展. 中国农村医学杂志, 2003, 1(3): 21-23.
5. Zander KE, Bower KA. Nursing case management: blueprints for transformation. Boston: New England Medical Center Hospital, 1987.
6. 王思成. 基于循证的中医临床路径研制方法研究. 北京: 北京中医药大学, 2010.
7. 蒲月英, 罗瑶, 王孝琦. 医院相关病种实施临床路径管理的效果分析. 中国卫生统计, 2014, 31(3): 463-464, 467.
8. 张爱武, 唐红, 罗晓勘. 临床路径与循证医学相关性初探. 中国卫生事业管理, 2011, 28(9): 678-679, 717.
9. 夏景林, 李敏奇, 陈英耀, 等. 公立医院临床医师临床路径应用状况分析. 中国医院管理, 2017, 37(7): 5-8.
10. 方朕. 临床路径管理模式在医院管理中的应用现状分析. 中国医药导报, 2017, 14(10): 166-169.
11. 中华人民共和国卫生部. 医疗机构临床路径的制定与实施. Available at: http://www.moh.gov.cn/zwgkzt/s9494/201209/55887.shtml.
12. 国家卫生计生委办公厅关于实施有关病种临床路径的通知.Available at: Http://www.nhfpc.gov.cn/yzygj/s7659/201612/e02b9324fc344f45979b6c20d7497b71.shtml.
13. 崔琦, 黄迪, 宋旭萍, 等. 临床路径评价工具及报告规范的比较分析. 中国循证医学杂志, 2015, 15(7): 810-815.
14. Bailey DA, Litaker DG, Mion LC. Developing better critical paths in healthcare: combining 'best practice' and the quantitative approach. J Nurs Adm, 1998, 28(7-8): 21-26.
15. Calligaro KD, Dougherty MJ, Raviola CA, et al. Impact of clinical pathways on hospital costs and early outcome after major vascular surgery. J Vasc Surg, 1995, 22(6): 649-657.
16. Koch MO, Smith JA Jr. Influence of patient age and co-morbidity on outcome of a collaborative care pathway after radical prostatectomy and cystoprostatectomy. J Urol, 1996, 155(5): 1681-1684.
17. Grimshaw J, Eccles M, Thomas R, et al. Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966-1998. J Gen Intern Med, 2006, 21(Suppl 2): S14-20.
18. Woolf SH, Grol R, Hutchinson A, et al. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ, 1999, 318(7182): 527-530.
19. 陈耀龙, 元博, 孙丽娜, 等. 中国大陆临床实践指南引文分析. 中国循证儿科杂志, 2013, 8(6): 467-470.
20. Chen Y, Yang K, Marušic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
21. 丁泓帆, 杨楠, 邓围, 等. WHO指南制定的基本原则和方法. 中国循证医学杂志, 2016, 16(4): 471-477.
22. 吴泽球. 高校教材滞后过时现象分析及对策. 高教论坛, 2008, (1): 124-126, 139.
23. 张世明. 从医学教育中的滞后现象谈教材改革的必要性. 苏州医学院学报, 1999, (10): 1062-1063.
24. 中华医学会外科学分会疝和腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊疗指南(2014年版). 中国实用外科杂志, 2014, 34(6): 484-486.
25. WHO. WHO Handbook for Guideline Development. Geneva: WHO Press, 2012.
26. Shekelle PG, Ortiz E, Rhodes S, et al. Validity of the agency for healthcare research and quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA, 2001, 286(12): 1461-1467.
27. Shekelle P, Eccles MP, Grimshaw JM, et al. When should clinical guidelines be updated? BMJ, 2001, 323(7305): 155-157.
28. Shojania KG, Sampson M, Ansari MT, et al. How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med, 2007, 147(4): 224-233.
29. Panel on antiretroviral guidelines for adults and adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Washington, DC: U.S. Department of Health and Human Services, 2008. Available at: http://aidsinfo.nih.gov/contentfiles/adultandadolescentgl.
30. 李幼平, 苏冠月, 喻佳洁. 循证评价对临床路径管理的作用: 思考与探索. 中国循证医学杂志, 2016, 16(11): 1250-1255.

Chinese Journal of Evidence-Based Medicine

An investigation of the sources of evidence of the clinical pathways in China

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