基于AGREE-HS评价的应急卫生系统指南推荐意见特点

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

摘要:

指南的推荐意见是通过共识形成的现有最佳证据的综合，构成了指南的主体和核心内容。该文基于卫生系统指南研究与评估系统（AGREE-HS）工具的“推荐意见”条目及其下的8项评价标准，分析以新型冠状病毒感染（COVID-19）指南为代表的应急卫生系统指南（HSG）推荐意见制定特点。为进一步探索应急HSG的推荐意见与非应急HSG的不同特点，该文将世界卫生组织（WHO）标准HSG作为对照。评价结果显示，“推荐意见”条目得分在5个条目中排名第2，仅次于“主题”条目。其中涉及可行性的标准7得分最高，涉及伦理原则的标准3得分最低。与标准HSG比较，除促进平等的标准4外，应急HSG的推荐意见得分及其他标准得分明显降低（P<0.05）。比较不同制定者的指南时，由WHO制定的指南推荐意见得分明显高于各国家制定的指南（P<0.05），尤其在标准4、涉及社会文化和政治利益的可接受性和一致性的标准5、涉及更新计划的标准8上表现突出。比较不同亚类的指南时，全球/国家战略层面的指南在涉及全面性的标准2得分明显高于具体临床或物资指导层面的指南（P<0.05）。总体而言，以COVID-19指南为代表的应急HSG与标准HSG在推荐意见方面存在诸多差异。应急HSG的内容表述更为凝练，对预期结果的阐述相对较弱，在全面性与伦理、平等、社会文化和政治利益等综合性要求方面有所取舍，同时重视更新计划。

Abstract:

Recommendations， consensus-based syntheses of the best available evidence， constitute the core content of a guideline. This paper analyzes the characteristics of emergency health systems guidance documents （HSGs）， represented by the coronavirus disease-2019 （COVID-19） emergency HSG， regarding the item "recommendations" and its eight evaluation criteria in the Appraisal of Guidelines for Research and Evaluation for Health Systems （AGREE-HS）. The World Health Organization （WHO） standard HSGs were used as reference to explore the characteristics of emergency HSGs that are different from non-emergency HSGs. The results showed that the “recommendations” scored second after “topic” among the five items. Criterion 7 relating to operability scored higher than others among the eight criteria， and criterion 3 dealing with ethical principles scored lower than other criteria. Compared with the standard HSGs， the emergency HSGs showed decreased scores （P<0.05） of the item recommendations and the criteria of this item except criterion 4 concerning equity promotion. Among the HSGs with different developers， those developed by the WHO had higher （P<0.05） scores of recommendations than nationally developed HSGs， as evidenced by criterion 4， criterion 5 involving acceptability to and alignment with sociocultural and political interests， and criterion 8 for updating plans. The HSGs regarding global or country strategy scored higher （P<0.05） on criterion 2 relating to comprehensiveness than those involving specific guidance on clinical or material issues. Overall， the emergency HSGs， represented by the COVID-19 emergency HSGs， differ from the standard HSGs in a number of ways in terms of their recommendations. Emergency HSGs have more condensed content and weaker articulation of expected outcomes. They incline to put more emphasis on updating plans， rather than comprehensiveness or integrative requirements in terms of ethics， equity， and sociocultural and political interests.