實證臨床指引建立方法與評估

Development of Evidence-Based Clinical Guidelines: Methods and Appraisals

以實證方法撰寫臨床照護指引報告是現階段進階 照護專家應具備的核心能力之一。一個全國性的 指引發展通常需歷時1至2年，其發展步驟包含： 組成指引發展小組、建構臨床相關問題、文獻 搜尋、證據評讀、形成建議共識、撰寫指引、 外部評估，以及執行與更新。透過多科整合指引 發展小組的運作，能依據特定族群的健康照護需 求，確立PICO問題，進行全面而完整的文獻搜 尋，運用客觀量化的評讀工具評析證據，經由 名義團體決策法、共識發展會議或德菲法形成共 識，並完成臨床照護指引的撰寫。指引執行之 前，尚需邀請專家運用指引發展品質評值工具， 進行嚴謹的審核，並尋求和整合人力及設備資 源，以促進指引的推展。推展後的指引，亦須訂 立定期更新時間表，以使該指引能與時俱進，歷 久不衰，並利於協助臨床照護者在特定狀況下， 做出適當的處置決策

 

Writing a report on clinical care guidelines by evidence-based process is one of the core capacities in present advanced healthcare experts. Developing a comprehensive guideline usually takes 1 to 2 years. The steps of development includes constructing a group for developing guidelines, asking relevant clinical questions, researching literatures, appraising the evidence, making consensus of recommendations, writing the documents of the clinical care guideline, and externally evaluating the quality of the guideline as well as implementing and renewing the guideline. Through the integration of multiple subjects to guide the operation, the development team can establish the PICO questions based on the healthcare needs of the target population, conduct an integrated and comprehensive literature review, use objective measured tools for appraisals, build consensus of recommendations by nominal ground technique, use consensus conference or Delphi technique, and write the guideline. Before promoting the implementation, it is necessary to invite experts to execute a rigorous evaluation of its developing quality using a qualified tool as well as seeking and integrating the workface and resource of the equipment. After the implementation, establishing a regular update schedule can promote the guideline’s advancement and flourishment, which can help care providers to make appropriate decisions in special situations.