An investigation of the sources of evidence of the clinical pathways in China_Chinese Journal of Evidence-Based Medicine

Authors：

XUN Yangqin ^1,2,3 ^# , CHENG Peng ⁴ ^# , LI Xiuxia ^1,2,3 , WEI Dang ² , YAO Liang ⁵ , PAN Bei ¹ , YAN Peijing ⁶ , XU Ke ¹ , LI Yanan ^1,2,3 , GUO Tiankang ⁶ ,  YANG Kehu ^2,3

1. School of Public Health, Lanzhou University, Lanzhou, 730000, P.R.China;
2. Evidence-Based Medicine Center, Lanzhou University, Lanzhou, 730000, P.R.China;
3. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, P.R.China;
4. Department of Orthopedics, Second Hospital of Lanzhou University, Lanzhou, 730030, P.R.China;
5. Chinese Medicine Faculty of Hong Kong Baptist University, HongKong, 999077, P.R.China;
6. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;

Corresponding?author：

YANG Kehu, Email: kehuyangebm2006@126.com

Keywords：

Clinical pathways; Evidence-based Medicine; Evidence

DOI：

10.7507/1672-2531.201801133

Video：

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ObjectivesTo investigate sources of evidence of the clinical pathways approved by the Chinese government.MethodsThe approved clinical pathways were obtained from the website of the National Health and Family Planning Commission. Two reviewers independently extracted the basic information, approval date, types of evidence of the clinical pathways and time of evidence. The variance analysis was performed for the diagnosis and treatment parts of clinical pathways and the LSD method was further used for comparison.ResultsThe main types of evidence were guidelines, textbooks, standard indicators and consensus views. Approximately 80% of the pathways cited clinical practice guidelines and 36% cited the textbooks. The median number of evidence for each clinical pathway was 2. Approximately 85% of the evidence could be obtained the time when the evidence published. The average time interval (between the time when the pathways released and the time when the evidence published) was 5.2 years. Specifically, textbooks constituted the largest proportion in all evidence that was over 15 years of time interval. In addition to the textbook comparison standard indicators, there were significant differences in time interval between guidelines or consensus and textbooks or standard indicators.Conclusions The evidence types selection is based on the concept of evidence-based medicine, yet the time span of the referred evidence is larger. Therefore, developing clinical pathways not only need to refer to the latest research evidence comprehensively and enhance transparency of clinical pathways, but also use evidence quality evaluation standards to evaluate and select the referred evidences.

Citation： XUN Yangqin, CHENG Peng, LI Xiuxia, WEI Dang, YAO Liang, PAN Bei, YAN Peijing, XU Ke, LI Yanan, GUO Tiankang, YANG Kehu. An investigation of the sources of evidence of the clinical pathways in China. Chinese Journal of Evidence-Based Medicine, 2018, 18(10): 1032-1036. doi: 10.7507/1672-2531.201801133 Copy

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30.	李幼平, 蘇冠月, 喻佳潔. 循證評價對臨床路徑管理的作用: 思考與探索. 中國循證醫學雜志, 2016, 16(11): 1250-1255.

1. Hassan IS. Knowledge translation through clinical pathways: principles for practical development and successful use. Saudi J Kidney Dis Transpl, 2013, 24(2): 351-363.
2. Mallock N. A template for clinical pathway design based on international evidence. Clinical Governance Bulletin, 2005, 5(5): 2-4.
3. Kinsman L, Rotter T, James E, et al. What is a clinical pathway? Development of a definition to inform the debate. BMC Med, 2010, 8: 31.
4. 李清華. 臨床路徑的現狀和發展. 中國農村醫學雜志, 2003, 1(3): 21-23.
5. Zander KE, Bower KA. Nursing case management: blueprints for transformation. Boston: New England Medical Center Hospital, 1987.
6. 王思成. 基于循證的中醫臨床路徑研制方法研究. 北京: 北京中醫藥大學, 2010.
7. 蒲月英, 羅瑤, 王孝琦. 醫院相關病種實施臨床路徑管理的效果分析. 中國衛生統計, 2014, 31(3): 463-464, 467.
8. 張愛武, 唐紅, 羅曉勘. 臨床路徑與循證醫學相關性初探. 中國衛生事業管理, 2011, 28(9): 678-679, 717.
9. 夏景林, 李敏奇, 陳英耀, 等. 公立醫院臨床醫師臨床路徑應用狀況分析. 中國醫院管理, 2017, 37(7): 5-8.
10. 方朕. 臨床路徑管理模式在醫院管理中的應用現狀分析. 中國醫藥導報, 2017, 14(10): 166-169.
11. 中華人民共和國衛生部. 醫療機構臨床路徑的制定與實施. Available at: http://www.moh.gov.cn/zwgkzt/s9494/201209/55887.shtml.
12. 國家衛生計生委辦公廳關于實施有關病種臨床路徑的通知.Available at: Http://www.nhfpc.gov.cn/yzygj/s7659/201612/e02b9324fc344f45979b6c20d7497b71.shtml.
13. 崔琦, 黃迪, 宋旭萍, 等. 臨床路徑評價工具及報告規范的比較分析. 中國循證醫學雜志, 2015, 15(7): 810-815.
14. Bailey DA, Litaker DG, Mion LC. Developing better critical paths in healthcare: combining 'best practice' and the quantitative approach. J Nurs Adm, 1998, 28(7-8): 21-26.
15. Calligaro KD, Dougherty MJ, Raviola CA, et al. Impact of clinical pathways on hospital costs and early outcome after major vascular surgery. J Vasc Surg, 1995, 22(6): 649-657.
16. Koch MO, Smith JA Jr. Influence of patient age and co-morbidity on outcome of a collaborative care pathway after radical prostatectomy and cystoprostatectomy. J Urol, 1996, 155(5): 1681-1684.
17. Grimshaw J, Eccles M, Thomas R, et al. Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966-1998. J Gen Intern Med, 2006, 21(Suppl 2): S14-20.
18. Woolf SH, Grol R, Hutchinson A, et al. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ, 1999, 318(7182): 527-530.
19. 陳耀龍, 元博, 孫麗娜, 等. 中國大陸臨床實踐指南引文分析. 中國循證兒科雜志, 2013, 8(6): 467-470.
20. Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
21. 丁泓帆, 楊楠, 鄧圍, 等. WHO指南制定的基本原則和方法. 中國循證醫學雜志, 2016, 16(4): 471-477.
22. 吳澤球. 高校教材滯后過時現象分析及對策. 高教論壇, 2008, (1): 124-126, 139.
23. 張世明. 從醫學教育中的滯后現象談教材改革的必要性. 蘇州醫學院學報, 1999, (10): 1062-1063.
24. 中華醫學會外科學分會疝和腹壁外科學組, 中國醫師協會外科醫師分會疝和腹壁外科醫師委員會. 成人腹股溝疝診療指南(2014年版). 中國實用外科雜志, 2014, 34(6): 484-486.
25. WHO. WHO Handbook for Guideline Development. Geneva: WHO Press, 2012.
26. Shekelle PG, Ortiz E, Rhodes S, et al. Validity of the agency for healthcare research and quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA, 2001, 286(12): 1461-1467.
27. Shekelle P, Eccles MP, Grimshaw JM, et al. When should clinical guidelines be updated? BMJ, 2001, 323(7305): 155-157.
28. Shojania KG, Sampson M, Ansari MT, et al. How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med, 2007, 147(4): 224-233.
29. Panel on antiretroviral guidelines for adults and adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Washington, DC: U.S. Department of Health and Human Services, 2008. Available at: http://aidsinfo.nih.gov/contentfiles/adultandadolescentgl.
30. 李幼平, 蘇冠月, 喻佳潔. 循證評價對臨床路徑管理的作用: 思考與探索. 中國循證醫學雜志, 2016, 16(11): 1250-1255.

Chinese Journal of Evidence-Based Medicine

An investigation of the sources of evidence of the clinical pathways in China

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