基于AGREE-HS评价的应急卫生系统指南制定方法特点

Characteristics of Developing Methods for Emergency Health Systems Guidance Based on AGREE-HS

摘要:

应急卫生系统指南制定方法的科学性和有效性对于保障指南质量、可靠性和实用性具有重要作用。采用卫生系统指南研究与评估系统（AGREE-HS）评价工具，对全球新型冠状病毒感染（COVID-19）卫生系统指南和世界卫生组织（WHO）标准卫生系统指南进行示范性评价，旨在探索应急卫生系统指南制定方法的核心特点。评价结果显示，在AGREE-HS的5个评价条目中，纳入的34份应急卫生系统指南“方法”条目得分位居第3，低于“主题”和“推荐意见”。其中，标准2（考虑了最有效和最相关的证据）得分最高，标准5（描述了潜在选择的成本和成本效益的证据）得分最低。与WHO标准卫生系统指南比较，COVID-19卫生系统指南在“方法”条目上的得分较低（P<0.05），且在9项标准中均有体现（P<0.05），尤其是标准1（采用系统、透明的方法对证据进行识别和审查）和标准9（采用系统和透明的方法商定最终的推荐意见）。在COVID-19应急卫生系统指南内部比较中，除标准8外，WHO制定指南的其他8项标准得分明显高于各国指南（P<0.05）；在分类评价中，临床相关类指南的标准3（证据基础是最新的）和标准8（推荐意见背后的论据很清楚）得分相对较高。总体而言，以COVID-19指南为代表的应急卫生系统指南的制定方法强调证据导向，并引入专家共识，具有证据合成策略灵活、证据审查流程简化及情境化的特点，受外部、内部和具体执行等多因素影响。

Abstract:

The scientific rigor and efficacy of methodologies employed in drafting emergency health systems guidance documents （HSGs） are paramount in guaranteeing the quality， reliability， and applicability of HSGs. According to the Appraisal of Guidelines for Research and Evaluation- Health Systems （AGREE-HS）， we demonstratively assessed both global coronavirus disease-2019 （COVID-19） emergency HSGs and World Health Organization （WHO） standard HSGs to uncover the core attributes of methods employed in the development of emergency HSGs. Our evaluation findings revealed that across the five assessment items of AGREE-HS， methods in the 34 emergency HSGs evaluated ranked third， trailing behind topic and recommendations. Notably， criterion 2 （the best available and most contextually relevant evidence is considered） received the highest score， whereas criterion 5 （evidence of cost and cost-effectiveness of the potential options is described） scored the lowest. Compared with the WHO standard HSGs， the COVID-19 emergency HSGs exhibited low scores in methods （P<0.05）， which was reflected in nine criteria （P<0.05）， especially in criteria 1 （systematic and transparent methods are used to identify and review the evidence） and 9 （systematic and transparent methods are used to agree upon the final recommendations）. Among the COVID-19 emergency HSGs， that developed by the WHO achieved higher scores in eight out of all nine criteria， excluding criterion 8 （P<0.05）. The clinically relevant emergency HSGs had higher scores in the criteria 3 （the evidence base is current） and 8 （the rationale behind the recommendations is clear） than other types of emergency HSGs. Collectively， the methodology for developing emergency HSGs， represented by the COVID-19 emergency HSG， underscores evidence orientation and integrates expert consensus. It is characterized by adaptable evidence synthesis strategies， streamlined evidence review protocols， and contextual relevance， all of which are influenced by external， internal， and implementation-specific factors.