知證衛生決策工具之二——如何改進機構知證決策的方法*_《中國循證醫學雜志》

作者：

Andrew D Oxman ¹ , Per Olav Vandvik ² , John N Lavis ³ , Atle Fretheim ⁴ , Simon Lewin ⁵

關鍵詞：

DOI：

10.7507/1672-2531.20100394

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本文旨在介紹如何進行知證衛生決策的組織方法。促進研究與實踐結合的一系列活動包括：與決策者高度相關的研究證據的生產和恰當的合成，促進研究與實踐結合的諸多努力，以及對其的評估。幾乎沒人知道如何更好地開展此類系列活動，直到最近才有很少幾個機構專門負責研究利用證據制定衛生政策。為此本文通過提出5 個問題來指導開展機構措施以支持研究證據在知證衛生決策中的使用：① 您所在機構進行知證決策的能力是什么? ② 應采用什么策略確保決策者、研究者和利益相關者之間的合作? ③ 應采用什么策略確保研究的獨立性和有效管理利益沖突? ④ 應采用什么策略確保使用系統和透明的方法獲取、評價和利用研究證據？⑤ 應采用什么策略以確保有足夠能力運用這些方法？

引用本文： Andrew D Oxman,Per Olav Vandvik,John N Lavis,Atle Fretheim,Simon Lewin. 知證衛生決策工具之二——如何改進機構知證決策的方法*. 中國循證醫學雜志, 2010, 10(3): 247-254. doi: 10.7507/1672-2531.20100394 復制

1.	Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst, 7(Suppl 1): I1.
2.	Granados A, Jonsson E, Banta HD, et al. EUR-ASSESS Project Subgroup Report on Dissemination and Impact. Int J Technol Assess Health Care, 1997, 13: 220-286.
3.	Sevene E, Lewin S, Marino A, et al. Can a drug be too cheap? The unavailability of magnesium sulphate for the treatment of eclampsia and preeclampsia in Mozambique and Zimbabwe: systems and market failures. BMJ, 2005, 331: 765.
4.	Trostle J, Bronfman M, Langer A. How do researchers influence decision-makers? Case studies of Mexican policies. Health Policy Plan, 1999, 14: 103-114.
5.	Working Group on Research to Action and Policy: Lessons in Research to Action and Policy – Case studies from seven countries. [http://www.cohred.org/libarchive/content/696.pdf] webcite Council of Health Research and Development (COHRED); 2000.
6.	Tomson G, Paphassarang C, Jonsson K, et al. Decision-makers and the usefulness of research evidence in policy implementation--a case study from Lao PDR. Soc Sci Med, 2005, 61: 1291-1299.
7.	Aaserud M, Lewin S, Innvaer S, et al. Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia. BMC Health Serv Res, 2005, 5: 68.
8.	Albert MA, Fretheim A, Maiga D. Factors influencing the utilization of research findings by health policy-makers in a developing country: the selection of Mali’s essential medicines. Health Res Policy Syst, 2007, 5: 2.
9.	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.
10.	Innvaer S, Vist G, Trommald M, Oxman A. Health policy-makers’ perceptions of their use of evidence: a systematic review. J Health Serv Res Policy, 2002, 7: 239-244.
11.	Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof, 2006, 26: 13-24.
12.	Nutley S, Walter I, Davies HTO. From knowing to doing: a framework for understanding the evidence-into-practice agenda. Evaluation, 2003, 9: 125-148.
13.	Sauerborn R, Nitayarumphong S, Gerhardus A. Strategies to enhance the use of health systems research for health sector reform. Trop Med Int Health, 1999, 4: 827-835.
14.	Lomas J. Connecting research and policy. Can J Policy Res, 2000, 1: 140-144.
15.	Dobbins M, Ciliska D, Cockerill R, et al. A framework for the dissemination and utilization of research for health-care policy and practice. Online J Knowl Synth Nurs, 2002, 9: 7.
16.	Jacobson N, Butterill D, Goering P. Development of a framework for knowledge translation: understanding user context. J Health Serv Res Policy, 2003, 8: 94-99.
17.	Lavis JN, Robertson D, Woodside JM, et al. How can research organizations more effectively transfer research knowledge to decision makers? Milbank Q, 2003, 81: 221-222.
18.	Dobrow MJ, Goel V, Lemieux-Charles L, et al. The impact of context on evidence utilization: a framework for expert groups developing health policy recommendations. Soc Sci Med, 2006, 63: 1811-1824.
19.	Bowen S, Zwi AB. Pathways to “evidence-informed” policy and practice: a framework for action. PLoS Med, 2005, 2: e166.
20.	Lavis JN, Lomas J, Hamid M, et al. Assessing country-level efforts to link research to action. Bull World Health Organ, 2006, 84: 620-628.
21.	Moynihan R, Oxman A, Lavis JN, et al. Evidence-Informed Health Policy: Using Research to Make Health Systems Healthier. [http:// www.kunnskapssenteret.no/binary?download=true&id=765] webcite Nasjonalt kunnskapssenter for helsetjenesten; 2008.
22.	Hamid M, Bustamante-Manaog T, Dung TV, et al. EVIPNet: translating the spirit of Mexico. Lancet, 2005, 366: 1758-1759.
23.	The Canadian Health Services Research Foundation (CHSRF): Is research working for you? A self-assessment tool and discussion guide for health services management and policy organizations. [http:// www.chsrf.ca/other_documents/working_e.php] webcite Canadian health Services Research Foundation; 2008.
24.	Thornhill J, Judd M, Clements D. CHSRF knowledge transfer: (re)introducing the self-assessment tool that is helping decisionmakers assess their organization’s capacity to use research. Healthc Q, 2009, 12: 22-24.
25.	Grol R, Wensing M, Eccles M. Improving patient care: implementing change in clinical practice. Oxford, Elsevier; 2005.
26.	Oxman AD, Fretheim A, Schunemann HJ. Improving the use of research evidence in guideline development: introduction. Health Res Policy Syst, 2006, 4: 12.
27.	Akl EA, Treweek S, Foy R, et al. NorthStar, a support tool for the design and evaluation of quality improvement interventions in healthcare. Implement Sci, 2007, 2: 19.
28.	Alliance for Health Policy and Systems Research: Strengthening health systems: the role and promise of policy and systems research. [http://www.who.int/alliance-hpsr/resources/ Strengthening_complet.pdf] webcite Alliance for Health Policy and Systems Research; 2004.
29.	Taylor R, Reeves B, Mears R, et al. Development and validation of a questionnaire to evaluate the effectiveness of evidence-based practice teaching. Med Educ, 2001, 35: 544-547.
30.	Johnston JM, Leung GM, Fielding R, et al. The development and validation of a knowledge, attitude and behaviour questionnaire to assess undergraduate evidence-based practice teaching and learning. Med Educ, 2003, 37: 992-1000.
31.	Ramos KD, Schafer S, Tracz SM. Validation of the Fresno test of competence in evidence based medicine. BMJ, 2003, 326: 319-321.
32.	Kothari A, Edwards N, Hamel N, et al. Is research working for you? Validating a tool to examine the capacity of health organizations to use research. Implement Sci, 2009, 4: 46.
33.	Gonzalez-Block MA, Mercado FJ, Ochoa H, et al. Utilización de investigación por gestores de salud. Desarrollo y validación de una herramienta de autodiagnóstico para países de habla hispana. Salud Publica Mex, 2008, 50: 490-497.
34.	Lomas J. The in-between world of knowledge brokering. BMJ, 2007, 334: 129-32.
35.	Lavis JN, Permanand G, Oxman AD, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 13. Preparing and using policy briefs to support evidence-informed policymaking. Health Res Policy Syst, in press.
36.	Lavis JN, Boyko J, Oxman AD, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 14. Organising and using policy dialogues to support evidence-informed policymaking. Health Res Policy Syst, 7(Suppl 1): S14.
37.	The Canadian Health Services Research Foundation (CHSRF): Executive Training for Research Application (EXTRA). [http://www. chsrf.ca/extra] webcite Canadian Health Services Research Foundation; 2009.
38.	Fox DM, Greenfield L. Helping public officials use research evaluating healthcare. J Law Policy, 2006, 14: 531-550.
39.	Jewell CJ, Bero LA. “Developing good taste in evidence”: Facilitators of and hindrances to evidence-informed health policymaking in state government. Milbank Quarterly, 2008, 86: 177-208.
40.	Oxman AD, Lewin S, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 15. Engaging the public in evidence-informed policymaking. Health Res Policy Syst, 7(Suppl 1): S15.
41.	Nilsen ES, Myrhaug HT, Johansen M, et al. Methods of consumer involvement in developing healthcare policy and research, clinical practice guidelines and patient information material. Cochrane Database Syst Rev, 2006, 3: CD004563.
42.	Milne R, Oliver S. Evidence-based consumer health information: developing teaching in critical appraisal skills. Int J Qual Health Care, 1996, 8: 439-445.
43.	Dickersin K, Braun L, Mead M, et al. Development and implementation of a science training course for breast cancer activists: Project LEAD (leadership, education and advocacy development). Health Expect, 2001, 4: 213-220.
44.	United States Cochrane Center: Understanding evidence-based healthcare: a foundation for action. [http://apps1.jhsph.edu/cochrane/ CUEwebcourse.htm] webcite United States Cochrane Centre; 2009.
45.	Grilli R, Ramsay C, Minozzi S. Mass media interventions: effects on health services utilisation. Cochrane Database Syst Rev, 2002, 1: CD000389.
46.	Boyd EA, Bero LA. Improving the use of research evidence in guideline development: 4. Managing conflicts of interests. Health Res Policy Syst, 2006, 4: 16.
47.	Oxman AD, Schunemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 8. Synthesis and presentation of evidence. Health Res Policy Syst, 2006, 4: 20.
48.	Schunemann HJ, Fretheim A, Oxman AD. Improving the use of research evidence in guideline development: 1. Guidelines for guidelines. Health Res Policy Syst, 2006, 4: 13.
49.	Green A, Bennett S. Sound Choices: Enhancing Capacity for Evidence- Informed Health Policy. [http://www.who.int/alliance-hpsr/ resources/Alliance_BR.pdf] webcite World Health Organization; 2007.
50.	Culyer AJ. Involving stakeholders in healthcare decisions--the experience of the National Institute for Health and Clinical Excellence (NICE) in England and Wales. Healthc Q, 2005, 8: 56-60.
51.	de Joncheere K, Hill SR, Klazinga N, et al. The Clinical Guideline Programme of the National Institute for Health and Clinical Excellence. A review by the WHO. [http://www.nice.org.uk/niceMedia/ pdf/boardmeeting/brdjan07item2b.pdf] webcite NICE; 2007.
52.	National Institute for Health and Clinical Excellence: About the Patient and Public Involvement Programme (PPIP). [http://www.nice. org.uk/media/D44/49/AboutPPIP.pdf] webcite National Institute for Health and Clinical Excellence; 2009.
53.	Oxman AD, Lavis JN, Fretheim A. The use of evidence in WHO recommendations. Lancet, 2007, 369: 1883-1889.
54.	Hill S, Pang T. Leading by example: a culture change at WHO. Lancet, 2007, 369: 1842-1844.
55.	Lancet editorial. WHO signals strong commitment to evidence. Lancet, 2007, 369(9574): 1666.
56.	EVIPNet Americas Secretariat. EVIPNet Americas: informing policies with evidence. Lancet, 2008, 372: 1130-1131.
57.	van Kammen J, de Savigny D, Sewankambo N. Using knowledge brokering to promote evidence-based policy-making: The need for support structures. Bull World Health Organ, 2006, 84: 608-612.
58.	Andersen KS. The reforming states group and the promotion of federalism. Milbank Q, 1998, 76: 103-120.
59.	Center for Evidence-based Policy: Addressing public policy challenges by identifying and applying best available evidence through self-governing communities of interest. [http://www.ohsu.edu/ohsuedu/ research/policycenter/index.cfm] webcite Center for Evidencebased Policy; 2009.

1. Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst, 7(Suppl 1): I1.
2. Granados A, Jonsson E, Banta HD, et al. EUR-ASSESS Project Subgroup Report on Dissemination and Impact. Int J Technol Assess Health Care, 1997, 13: 220-286.
3. Sevene E, Lewin S, Marino A, et al. Can a drug be too cheap? The unavailability of magnesium sulphate for the treatment of eclampsia and preeclampsia in Mozambique and Zimbabwe: systems and market failures. BMJ, 2005, 331: 765.
4. Trostle J, Bronfman M, Langer A. How do researchers influence decision-makers? Case studies of Mexican policies. Health Policy Plan, 1999, 14: 103-114.
5. Working Group on Research to Action and Policy: Lessons in Research to Action and Policy – Case studies from seven countries. [http://www.cohred.org/libarchive/content/696.pdf] webcite Council of Health Research and Development (COHRED); 2000.
6. Tomson G, Paphassarang C, Jonsson K, et al. Decision-makers and the usefulness of research evidence in policy implementation--a case study from Lao PDR. Soc Sci Med, 2005, 61: 1291-1299.
7. Aaserud M, Lewin S, Innvaer S, et al. Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia. BMC Health Serv Res, 2005, 5: 68.
8. Albert MA, Fretheim A, Maiga D. Factors influencing the utilization of research findings by health policy-makers in a developing country: the selection of Mali’s essential medicines. Health Res Policy Syst, 2007, 5: 2.
9. 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.
10. Innvaer S, Vist G, Trommald M, Oxman A. Health policy-makers’ perceptions of their use of evidence: a systematic review. J Health Serv Res Policy, 2002, 7: 239-244.
11. Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof, 2006, 26: 13-24.
12. Nutley S, Walter I, Davies HTO. From knowing to doing: a framework for understanding the evidence-into-practice agenda. Evaluation, 2003, 9: 125-148.
13. Sauerborn R, Nitayarumphong S, Gerhardus A. Strategies to enhance the use of health systems research for health sector reform. Trop Med Int Health, 1999, 4: 827-835.
14. Lomas J. Connecting research and policy. Can J Policy Res, 2000, 1: 140-144.
15. Dobbins M, Ciliska D, Cockerill R, et al. A framework for the dissemination and utilization of research for health-care policy and practice. Online J Knowl Synth Nurs, 2002, 9: 7.
16. Jacobson N, Butterill D, Goering P. Development of a framework for knowledge translation: understanding user context. J Health Serv Res Policy, 2003, 8: 94-99.
17. Lavis JN, Robertson D, Woodside JM, et al. How can research organizations more effectively transfer research knowledge to decision makers? Milbank Q, 2003, 81: 221-222.
18. Dobrow MJ, Goel V, Lemieux-Charles L, et al. The impact of context on evidence utilization: a framework for expert groups developing health policy recommendations. Soc Sci Med, 2006, 63: 1811-1824.
19. Bowen S, Zwi AB. Pathways to “evidence-informed” policy and practice: a framework for action. PLoS Med, 2005, 2: e166.
20. Lavis JN, Lomas J, Hamid M, et al. Assessing country-level efforts to link research to action. Bull World Health Organ, 2006, 84: 620-628.
21. Moynihan R, Oxman A, Lavis JN, et al. Evidence-Informed Health Policy: Using Research to Make Health Systems Healthier. [http:// www.kunnskapssenteret.no/binary?download=true&id=765] webcite Nasjonalt kunnskapssenter for helsetjenesten; 2008.
22. Hamid M, Bustamante-Manaog T, Dung TV, et al. EVIPNet: translating the spirit of Mexico. Lancet, 2005, 366: 1758-1759.
23. The Canadian Health Services Research Foundation (CHSRF): Is research working for you? A self-assessment tool and discussion guide for health services management and policy organizations. [http:// www.chsrf.ca/other_documents/working_e.php] webcite Canadian health Services Research Foundation; 2008.
24. Thornhill J, Judd M, Clements D. CHSRF knowledge transfer: (re)introducing the self-assessment tool that is helping decisionmakers assess their organization’s capacity to use research. Healthc Q, 2009, 12: 22-24.
25. Grol R, Wensing M, Eccles M. Improving patient care: implementing change in clinical practice. Oxford, Elsevier; 2005.
26. Oxman AD, Fretheim A, Schunemann HJ. Improving the use of research evidence in guideline development: introduction. Health Res Policy Syst, 2006, 4: 12.
27. Akl EA, Treweek S, Foy R, et al. NorthStar, a support tool for the design and evaluation of quality improvement interventions in healthcare. Implement Sci, 2007, 2: 19.
28. Alliance for Health Policy and Systems Research: Strengthening health systems: the role and promise of policy and systems research. [http://www.who.int/alliance-hpsr/resources/ Strengthening_complet.pdf] webcite Alliance for Health Policy and Systems Research; 2004.
29. Taylor R, Reeves B, Mears R, et al. Development and validation of a questionnaire to evaluate the effectiveness of evidence-based practice teaching. Med Educ, 2001, 35: 544-547.
30. Johnston JM, Leung GM, Fielding R, et al. The development and validation of a knowledge, attitude and behaviour questionnaire to assess undergraduate evidence-based practice teaching and learning. Med Educ, 2003, 37: 992-1000.
31. Ramos KD, Schafer S, Tracz SM. Validation of the Fresno test of competence in evidence based medicine. BMJ, 2003, 326: 319-321.
32. Kothari A, Edwards N, Hamel N, et al. Is research working for you? Validating a tool to examine the capacity of health organizations to use research. Implement Sci, 2009, 4: 46.
33. Gonzalez-Block MA, Mercado FJ, Ochoa H, et al. Utilización de investigación por gestores de salud. Desarrollo y validación de una herramienta de autodiagnóstico para países de habla hispana. Salud Publica Mex, 2008, 50: 490-497.
34. Lomas J. The in-between world of knowledge brokering. BMJ, 2007, 334: 129-32.
35. Lavis JN, Permanand G, Oxman AD, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 13. Preparing and using policy briefs to support evidence-informed policymaking. Health Res Policy Syst, in press.
36. Lavis JN, Boyko J, Oxman AD, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 14. Organising and using policy dialogues to support evidence-informed policymaking. Health Res Policy Syst, 7(Suppl 1): S14.
37. The Canadian Health Services Research Foundation (CHSRF): Executive Training for Research Application (EXTRA). [http://www. chsrf.ca/extra] webcite Canadian Health Services Research Foundation; 2009.
38. Fox DM, Greenfield L. Helping public officials use research evaluating healthcare. J Law Policy, 2006, 14: 531-550.
39. Jewell CJ, Bero LA. “Developing good taste in evidence”: Facilitators of and hindrances to evidence-informed health policymaking in state government. Milbank Quarterly, 2008, 86: 177-208.
40. Oxman AD, Lewin S, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 15. Engaging the public in evidence-informed policymaking. Health Res Policy Syst, 7(Suppl 1): S15.
41. Nilsen ES, Myrhaug HT, Johansen M, et al. Methods of consumer involvement in developing healthcare policy and research, clinical practice guidelines and patient information material. Cochrane Database Syst Rev, 2006, 3: CD004563.
42. Milne R, Oliver S. Evidence-based consumer health information: developing teaching in critical appraisal skills. Int J Qual Health Care, 1996, 8: 439-445.
43. Dickersin K, Braun L, Mead M, et al. Development and implementation of a science training course for breast cancer activists: Project LEAD (leadership, education and advocacy development). Health Expect, 2001, 4: 213-220.
44. United States Cochrane Center: Understanding evidence-based healthcare: a foundation for action. [http://apps1.jhsph.edu/cochrane/ CUEwebcourse.htm] webcite United States Cochrane Centre; 2009.
45. Grilli R, Ramsay C, Minozzi S. Mass media interventions: effects on health services utilisation. Cochrane Database Syst Rev, 2002, 1: CD000389.
46. Boyd EA, Bero LA. Improving the use of research evidence in guideline development: 4. Managing conflicts of interests. Health Res Policy Syst, 2006, 4: 16.
47. Oxman AD, Schunemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 8. Synthesis and presentation of evidence. Health Res Policy Syst, 2006, 4: 20.
48. Schunemann HJ, Fretheim A, Oxman AD. Improving the use of research evidence in guideline development: 1. Guidelines for guidelines. Health Res Policy Syst, 2006, 4: 13.
49. Green A, Bennett S. Sound Choices: Enhancing Capacity for Evidence- Informed Health Policy. [http://www.who.int/alliance-hpsr/ resources/Alliance_BR.pdf] webcite World Health Organization; 2007.
50. Culyer AJ. Involving stakeholders in healthcare decisions--the experience of the National Institute for Health and Clinical Excellence (NICE) in England and Wales. Healthc Q, 2005, 8: 56-60.
51. de Joncheere K, Hill SR, Klazinga N, et al. The Clinical Guideline Programme of the National Institute for Health and Clinical Excellence. A review by the WHO. [http://www.nice.org.uk/niceMedia/ pdf/boardmeeting/brdjan07item2b.pdf] webcite NICE; 2007.
52. National Institute for Health and Clinical Excellence: About the Patient and Public Involvement Programme (PPIP). [http://www.nice. org.uk/media/D44/49/AboutPPIP.pdf] webcite National Institute for Health and Clinical Excellence; 2009.
53. Oxman AD, Lavis JN, Fretheim A. The use of evidence in WHO recommendations. Lancet, 2007, 369: 1883-1889.
54. Hill S, Pang T. Leading by example: a culture change at WHO. Lancet, 2007, 369: 1842-1844.
55. Lancet editorial. WHO signals strong commitment to evidence. Lancet, 2007, 369(9574): 1666.
56. EVIPNet Americas Secretariat. EVIPNet Americas: informing policies with evidence. Lancet, 2008, 372: 1130-1131.
57. van Kammen J, de Savigny D, Sewankambo N. Using knowledge brokering to promote evidence-based policy-making: The need for support structures. Bull World Health Organ, 2006, 84: 608-612.
58. Andersen KS. The reforming states group and the promotion of federalism. Milbank Q, 1998, 76: 103-120.
59. Center for Evidence-based Policy: Addressing public policy challenges by identifying and applying best available evidence through self-governing communities of interest. [http://www.ohsu.edu/ohsuedu/ research/policycenter/index.cfm] webcite Center for Evidencebased Policy; 2009.

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知證衛生決策工具之二——如何改進機構知證決策的方法*

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《中國循證醫學雜志》

知證衛生決策工具之二——如何改進機構知證決策的方法*

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