基于AGREE-HS评价的应急卫生系统指南特点

Characteristics of Emergency Health Systems Guidance Based on AGREE-HS

摘要:

该研究采用卫生系统指南研究与评估系统（AGREE-HS）工具，对遴选的全球34份新型冠状病毒感染（COVID-19）应急卫生系统指南和6份世界卫生组织（WHO）标准卫生系统指南进行了示范性评价，评价条目包括主题、参与人员、方法、推荐意见和可实施性，旨在探索分析应急卫生系统指南的制定特点。评价结果显示，应急卫生系统指南的总体得分为49%，其中“主题”得分最高，“推荐意见”次之，“参与人员”得分最低；标准卫生系统指南的总体得分为79%，所有条目得分均较高。与标准卫生系统指南比较，应急卫生系统指南的“参与人员”“方法”“推荐意见”和“可实施性”得分显著降低（P<0.01），由WHO制定的COVID-19应急卫生系统指南在“主题”评分上优于标准卫生系统指南（P<0.05）。与各国家制定的COVID-19应急卫生系统指南比较，WHO指南在各条目和总体得分上均表现出显著优势（P<0.01）。分析表明，以COVID-19指南为代表的应急卫生系统指南与标准卫生系统指南同样重视主题和推荐意见，前者对制定专家参与度、证据依据充分性、综合考量全面性的要求有所弱化，具有突出主题、制定目的明确、围绕需求导向、紧跟最新证据、灵活调整、确保指南时效性，强调即时实施效果、弱化远期影响、注重综合效益等特点。此外，制定主体、指南类型及报告完整度是重要的影响因素。

Abstract:

This study used the Appraisal of Guidelines Research & Evaluation-Health Systems （AGREE-HS） to demonstratively compare 34 global coronavirus disease-2019 （COVID-19） health systems guidance documents （HSGs） and 6 World Health Organization （WHO） standard HSGs. The comparison involved topic， participants， methods， recommendations， and implementability， with the aim of exploring the characteristics of emergency HSGs. The results showed that the emergency HSGs had an overall average score of 49%， with topic having the highest score， recommendations having the second highest score， and participants having the lowest score. The standard HSGs had an overall average score of 79%， with high scores in all items. The emergency HSGs had lower scores in participants， methods， recommendations， and implementability than the standard HSGs （P<0.001）， while the COVID-19 emergency HSGs developed by the WHO had higher score in topic than the standard HSGs （P<0.05）. Compared with those released by countries， the COVID-19 emergency HSG developed by the WHO showed superiority in all items and overall scores （P=0.000 2）. This indicates that emergency HSGs， represented by the COVID-19 emergency HSG， place equal emphasis on topic and recommendations as standard HSGs but have low requirements in terms of expert participation， evidence support， and comprehensive consideration in the time- and resource-limited context. They have the characteristics of prominent topics， clear purposes， orientation to demand， keeping up with the latest evidence， flexible adjustment， and timeliness， emphasizing immediate implementation effects， weakening long-term effects， and focusing on comprehensive benefits. Additionally， developers， types， and report completeness are important influencing factors.