知證衛生決策工具之五——使用證據擬訂解決問題的方案*_《中國循證醫學雜志》

作者：

John N Lavis , Michael G Wilson , Andrew D Oxman , Jeremy Grimshaw , Simon Lewin , Atle Fretheim

關鍵詞：

DOI：

10.7507/1672-2531.20100397

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決策者及其決策支持者可能會面臨以下三種情況中的一種或多種，均需要他們評估擬訂方案的成本和效果。這三種情況如下：① 當做出決策后，決策者及其決策支持者需考慮如何使該方案的獲益最大化、危害最小化、資金使用最優化。如果方案可能需要的成本及產生的效果都存在很大不確定性時，還需制定監測和評估計劃；②決策過程中，決策者及其決策支持者需要對提交上來的方案進行評估；③ 決策尚未做出前，決策者及其決策支持者需開展確定方案、分析方案不同的成本和效果、尋找實施方案的最佳時機。上述情況下，研究證據，特別是有關利弊評估及成本分析方面的證據可幫助決策者及其決策支持者了解方案的可行性。本文將列出以下6 個問題供那些為解決最優問題和評估項目成本和效果而需要理清政策和項目方案的人參考：① 是否已有一套解決問題的合理方案？② 哪些獲益對受方案影響者重要；每種方案將會產生哪些獲益？③ 哪些方案會嚴重影響受方案影響者；各種方案將產生哪些危害？④ 每種方案的當地成本是多少；是否有各種方案成本效果研究的當地證據？⑤ 執行任何一項“拿來方案”時應做出哪些相應的調整，其是否會改變方案的獲益、危害和成本？⑥ 哪些利益相關者的哪些意見和經驗可能影響方案的可接受性以及方案獲益、危害和成本？

引用本文： . 知證衛生決策工具之五——使用證據擬訂解決問題的方案*. 中國循證醫學雜志, 2010, 10(3): 269-275. doi: 10.7507/1672-2531.20100397 復制

1.	Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst, 2009, 7(Suppl 1): I1.
2.	Lavis JN, Wilson MG, Oxman AD, et al. SUPPORT Tools for evidence-informed health Policymaking (STP). 4. Using research evidence to clarify a problem. Health Res Policy Syst, 2009, 7(Suppl 1): S4.
3.	Fretheim A, Munabi-Babigumira S, Oxman AD, et al. SUPPORT Tools for evidence-informed health Policymaking (STP). 6. Using research evidence to address how an option will be implemented. Health Res Policy Syst, 2009, 7(Suppl 1): S6.
4.	Fretheim A, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 18. Planning monitoring and evaluation of policies. Health Res Policy Syst, 2009, 7(Suppl 1): S18.
5.	Kingdon JW: Agendas, Alternatives, and Public Policies 2nd edition. New York: Longman; 2003.
6.	Lavis JN, Davies HTO, Oxman A, et al. Towards systematic reviews that inform healthcare management and policymaking. J Health Serv Res Policy, 2005, 10: 35-48.
7.	Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q, 1996, 74: 511-544.
8.	Chopra M, Munro S, Lavis JN, et al. Effects of policy options for human resources for health: an analysis of systematic reviews. Lancet, 2008, 371: 668-674.
9.	Lavis JN, Oxman AD, Grimshaw J, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 7. Finding systematic reviews. Health Res Policy Syst, 2009, 7(Suppl 1): S7.
10.	Oxman AD, Fretheim A, Schuneman HJ. Improving the Use of Research Evidence in Guideline Development: 7. Deciding what evidence to include. Health Res Policy Syst, 2006, 4: 19.
11.	Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 11. Finding and using research evidence about local conditions. Health Res Policy Syst, 2009, 7(Suppl 1): S11.
12.	Oxman AD, Fretheim A, Lavis JN, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 12. Finding and using research evidence about resource use and costs. Health Res Policy Syst, 2009, 7(Suppl 1): S12.
13.	World Health Organization (WHO): Guidelines for the Treatment of Malaria Geneva, World Health Organization; 2006.
14.	Lewin SA, Dick J, Pond P, et al. Lay health workers in primary and community health care. Cochrane Database Syst Rev, 2005, 1: CD004015.
15.	Goodman C, Brieger W, Unwin A, et al. Medicine sellers and malaria treatment in sub-Saharan Africa: what do they do and how can their practice be improved? Am J Trop Med Hyg, 2007, 77(6 Suppl203-18 [http://www.ajtmh.org/cgi/reprint/77/6_Suppl/203].
16.	Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 8. Deciding how much confidence to place in a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S8.
17.	Oxman AD, Lavis JN, Fretheim A, et al. SUPPORT Tools for evidence-informed health Policymaking (STP). 16. Using research evidence in balancing the pros and cons of policies. Health Res Policy Syst, 2009, 7(Suppl 1): S16.
18.	Lavis JN, Oxman AD, Souza NM, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 9. Assessing the applicability of the findings of a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S10.
19.	Oxman AD, Lavis JN, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 10. Taking equity into consideration when assessing the findings of a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S10.

1. Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst, 2009, 7(Suppl 1): I1.
2. Lavis JN, Wilson MG, Oxman AD, et al. SUPPORT Tools for evidence-informed health Policymaking (STP). 4. Using research evidence to clarify a problem. Health Res Policy Syst, 2009, 7(Suppl 1): S4.
3. Fretheim A, Munabi-Babigumira S, Oxman AD, et al. SUPPORT Tools for evidence-informed health Policymaking (STP). 6. Using research evidence to address how an option will be implemented. Health Res Policy Syst, 2009, 7(Suppl 1): S6.
4. Fretheim A, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 18. Planning monitoring and evaluation of policies. Health Res Policy Syst, 2009, 7(Suppl 1): S18.
5. Kingdon JW: Agendas, Alternatives, and Public Policies 2nd edition. New York: Longman; 2003.
6. Lavis JN, Davies HTO, Oxman A, et al. Towards systematic reviews that inform healthcare management and policymaking. J Health Serv Res Policy, 2005, 10: 35-48.
7. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q, 1996, 74: 511-544.
8. Chopra M, Munro S, Lavis JN, et al. Effects of policy options for human resources for health: an analysis of systematic reviews. Lancet, 2008, 371: 668-674.
9. Lavis JN, Oxman AD, Grimshaw J, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 7. Finding systematic reviews. Health Res Policy Syst, 2009, 7(Suppl 1): S7.
10. Oxman AD, Fretheim A, Schuneman HJ. Improving the Use of Research Evidence in Guideline Development: 7. Deciding what evidence to include. Health Res Policy Syst, 2006, 4: 19.
11. Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 11. Finding and using research evidence about local conditions. Health Res Policy Syst, 2009, 7(Suppl 1): S11.
12. Oxman AD, Fretheim A, Lavis JN, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 12. Finding and using research evidence about resource use and costs. Health Res Policy Syst, 2009, 7(Suppl 1): S12.
13. World Health Organization (WHO): Guidelines for the Treatment of Malaria Geneva, World Health Organization; 2006.
14. Lewin SA, Dick J, Pond P, et al. Lay health workers in primary and community health care. Cochrane Database Syst Rev, 2005, 1: CD004015.
15. Goodman C, Brieger W, Unwin A, et al. Medicine sellers and malaria treatment in sub-Saharan Africa: what do they do and how can their practice be improved? Am J Trop Med Hyg, 2007, 77(6 Suppl203-18 [http://www.ajtmh.org/cgi/reprint/77/6_Suppl/203].
16. Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 8. Deciding how much confidence to place in a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S8.
17. Oxman AD, Lavis JN, Fretheim A, et al. SUPPORT Tools for evidence-informed health Policymaking (STP). 16. Using research evidence in balancing the pros and cons of policies. Health Res Policy Syst, 2009, 7(Suppl 1): S16.
18. Lavis JN, Oxman AD, Souza NM, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 9. Assessing the applicability of the findings of a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S10.
19. Oxman AD, Lavis JN, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 10. Taking equity into consideration when assessing the findings of a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S10.

《中國循證醫學雜志》

知證衛生決策工具之五——使用證據擬訂解決問題的方案*

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《中國循證醫學雜志》

知證衛生決策工具之五——使用證據擬訂解決問題的方案*

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