基于AGREE-HS评价的应急卫生系统指南主题特点

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

摘要:

应急卫生系统指南（HSG）主题的明确保证了指南内容的针对性、科学性和实用性，为快速、有效的公共卫生响应提供了清晰的方向和框架。该研究采用卫生系统指南研究与评估系统（AGREE-HS）评价工具，对以全球新型冠状病毒感染（COVID-19）HSG为代表的应急HSG和世界卫生组织（WHO）标准HSG进行了示范性评价，旨在探索应急HSG制定主题的特点。结果显示，纳入的34篇指南中，“主题”条目得分最高。特别是涉及相关且适用因素的标准4得分最高（5.59分），涉及卫生系统优先级别描述的标准3得分最低（2.76分）。标准1在标准HSG和整体应急HSG、WHO与各国应急HSG比较时差异有统计学意义（P<0.05），标准3在标准HSG与应急HSG、WHO与各国应急HSG比较时差异有统计学意义（P<0.05），标准4在WHO与各国应急HSG比较时差异有统计学意义（P<0.01）；应急HSG亚类评价中，组间、组内比较提示差异无统计学意义（P<0.05）。总体而言，应急HSG的主题注重详细描述卫生系统面临的挑战，涵盖挑战的性质、受影响人群等相关且适用的因素，与利益相关方的关注点保持一致；弱化优先级设定，重点在于快速响应和灵活应对紧迫问题。受证据基础、阶段反应时机和有效性等多种因素影响，主题设定有所差异。

Abstract:

The clear definition of the topic in emergency health systems guidance （HSG） ensures the relevance， scientific rigor， and practicality of the guidance， providing a clear direction and a framework for a rapid and effective public health response. This study used the Appraisal of Guidelines for Research & Evaluation-Health Systems （AGREE-HS） to demonstratively evaluate the global COVID-19 emergency HSGs and World Health Organization （WHO） standard HSGs， aiming to explore the characteristics of topic in emergency HSGs. The results showed that in the 34 HSGs included， the item topic received the highest score. Specifically， criterion 4 relating to relevant and applicable factors scored the highest （5.59）， while criterion 3 concerning the prioritization of health system challenges scored the lowest （2.76）. There were differences （P<0.05） in criterion 1 between standard HSGs and overall emergency HSGs， as well as between WHO and national emergency HSGs. Criterion 3 also showed differences （P<0.05） between standard HSGs and emergency HSGs， as well as between WHO and national emergency HSGs. Criterion 4 displayed differences （P<0.000 1） between WHO and national emergency HSGs. No differences were observed in intra-group or inter-group comparisons of different emergency HSG subcategories （P<0.05）. Overall， emergency HSGs represented by the COVID-19 emergency HSG focus on detailing the challenges faced by the health system， including the natures of challenges， affected populations， and other relevant and applicable factors， while aligning with stakeholder concerns. The prioritization is downplayed， with emphasis placed on rapid responses to and flexible handling of urgent issues. Influenced by factors such as the evidence base， phase timing， and effectiveness， the topic setting shows variations.