Guideline implementation with decision support checklist (GUIDES) aims to assist the self-reflection of evidence-based clinical decision support system (CDSS) related professionals to enhance the process monitor and continuous improvement of evidence-based CDSS. This paper interpreted the development process, target user, and assessment method of GUIDES, analyzed the practical value of GUIDES through a typical example, and then reflected on the GUIDES and current studies on evidence-based CDSS in China. It is expected to provide references for future studies.
This consensus aims to systematically standardize the establishment and management of multidisciplinary specialized disease centers within general hospitals. Based on the "1+5+7" framework (one core condition, five essential conditions, and seven enabling conditions), it clarifies the classification of centers by focusing on specific diseases, organs, or symptoms. The consensus emphasizes interdisciplinary coordination, integration of clinical specialties, and the advancement of specialized disease management, while also prioritizing improvements in patient care experience and the development of professional talent teams. It covers the full lifecycle of center development—including organizational structure, clinical services, teaching and research, and evaluation and management—providing a standardized operational pathway for the construction of specialized disease centers in general hospital settings.
ObjectiveTo analyse the quality of implementation in clinical application guidelines of the Chinese patent medicines for the treatment of common diseases. MethodsWe retrieved clinical application guidelines of the Chinese patent medicines for the treatment of common diseases published from February, 2019 to August, 2022 in databases. The clinical practice guideline (CPG) implementation evaluation tool was used to evaluate the implementation of the included guidelines. ResultsA total of 29 guidelines were included. The implementation quality of included guidelines was moderate. Thirteen (44.8%) were high quality and 16 (55.2%) were moderate quality. ConclusionThe quality of implementation of clinical application guidelines of the Chinese patent medicines for the treatment of common diseases is higher than that of other traditional Chinese medicine CPG. The CPG implementation evaluation tool can be used in traditional Chinese medicine CPGs and particularity of TCM should also be considered.
This article systematically reviews the series of articles on randomized controlled trial (RCT) methodology guidance published in JAMA Surgery between 2022 and 2023. It focuses on providing an overview and guidance on critical aspects such as trial implementation and oversight, participant recruitment, statistical applications, and key points in manuscript publication. The aim is to offer valuable insights and references for surgeons to conduct efficient clinical trials and successfully publish their research findings.
The RE-AIM framework is the most commonly used framework for implementation research outcome evaluation, with the original paper cited 2 800 times. However, in the specific operationalization process of the framework, there are often situations of misuse or overuse of various dimensions and indicators. This article provides a detailed introduction to the main content, application scenarios, and characteristics of the RE-AIM framework. Taking the implementation research of Evidence-based Practice Guidelines for Integrated Traditional Chinese and Western Medicine Treatment of Stroke as an example, it introduces how to use the silent & anonymous feedback technology, which combines the improved Delphi method and nominal group technique, to construct an implementation outcome indicator evaluation system to achieve the operability of the RE-AIM framework. This will provide a reference for other researchers to use implementation science theories, models, and frameworks to develop implementation plans or evaluate implementation outcomes.
Objective To review main obstacles to health care professionals' adherence to clinical practice guidelines (CPGs) by employing the scoping review method and a determinants framework, and to explore the effect of implementation strategies in intervention researches on guideline adherence. Methods The articles published from January 1, 2011 to June 10, 2023 were retrieved from the PubMed, CINAHL, MEDLINE, Embase, Scopus, Cochrane Library, SinoMed, CNKI, WanFang Data and VIP databases. The original literature on the CPGs implementation obstacles and strategies was included, and the primary and secondary screening of the literature were completed by four researchers according to the inclusion and exclusion criteria. The basic characteristics of the literature, the factors affecting the implementation of the CPGs, and the strategies used were extracted. The results were analyzed and summarized using qualitative and quantitative methods. Results A total of 61 articles were included in the scoping review. The factors affecting the implementation of CPGs could be divided into five categories: guidelines themselves, external factors, internal factors, individual factors, and implementation process. The most common implementation obstacles were insufficient knowledge or skills of professionals regarding guidelines (n=21, 34.4%), insufficient necessity of using guidelines according to doctors (n=17, 27.9%), and unreasonable factors within hospital (n=16, 26.2%). The factors that promoted the implementation of CPGs included guidelines based on high-quality evidence (n=5, 8.2%), good department or hospital culture (n=4, 6.6%), convenient accessibility of guideline knowledge and information (n=4, 6.6%), and doctors’ excellent professional ability (n=4, 6.6%). The overall effectiveness of the guideline implementation strategy was 50%. Clinical decision support system (CDSS) could improve the adherence of CPGs. Guideline education or training was one of the most commonly used methods, but the effect of improving guideline compliance was unstable. Conclusion The primary challenges in implementing guidelines include inadequate professional capacity and demand, suboptimal hospital infrastructure and limited resources. However, the obstacles are not absolute. It is recommended to use implementation strategies to improve the absorption and implementation of guidelines, among which CDSS is an effective measure for promoting guideline adherence.
ObjectiveTo systematically review the effect of implementing the medicines zero mark-up policy in Chinese public hospitals.MethodsCNKI, WanFang Data, VIP, Sinomed, Web of Science, PubMed and EMbase databases were electronically searched to collect quantitative evaluations of the effect of implementing the medicines zero mark-up policy in Chinese public hospitals from inception to October 30th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Descriptive analysis was then performed.ResultsThe existing evidence on the effect of implementing the medicines zero mark-up policy in Chinese public hospitals was from 3 studies based on national samples and 7 provincial level studies in Beijing, Shannxi and Fujian. After the implementation of the medicines zero mark-up policy, all included studies found that the medicines expenditure and the proportion of medicines expenditure to the total expenditure per outpatient visit or per hospitalization decreased. The expenditures of medical supplies, tests & examinations per outpatient visit or per hospitalization increased, and the medical expenditure per outpatient visit or per hospitalization increased in Beijing. The hospital annual revenue generated from medicines and its proportion to the total annual revenue both decreased across the country. Although the government allocated increased subsidy to compensate the revenue reduction of the public hospitals due to the implementation of the medicines zero-mark-up policy, the total annual revenue of traditional Chinese medicine hospitals at the county level across the country still decreased significantly.ConclusionsBased on the available evidence, we conclude that the policy objective of abolishing the mechanism of "compensating medical care with revenue generated from prescribing medicines" is achieved, while that of establishing a scientific compensation mechanism for public hospitals are partially achieved. Compared with other regions, Beijing has appropriately adjusted the prices of medical care while removing the mark-up of medicines, thus is a contributor to the establishment of a scientific compensation mechanism for public hospitals.
Compared with traditional medical devices, artificial intelligence medical devices face greater challenges in the process of clinical trials due to their related characteristics of artificial intelligence technology. This paper focused on the challenges and risks in each stage of clinical trials on artificial intelligence medical devices for assisted diagnosis, and put forward corresponding coping strategies, with the aim to provide references for the performance of high-quality clinical trials on artificial intelligence medical devices and shorten the research period in China.
The number of investigator initiated research (IIR) is increasing. But the recognition and management of IIR in China is still in its infancy, and there is a lack of specific and operable guidance for the implementation process. Based on our practical experiences, previous literature reports, and current policy regulations, the authors took prospective IIR as an example to summarize the implementation process of IIR into 14 steps, which are as the following: study initiation, ethical review, study registration, study filing, case report form design, database establishment, standard operating procedure making, investigator training, informed consent, data collection, data entry, data verification, data locking and data archiving.
Based on the national 2020 and 2022 versions of Accreditation Standards for Tertiary Hospital, the Hospitals Accreditation Office of the Sichuan Provincial Health Commission organized to develop Implementation Rules for the Accreditation Standards for Tertiary Comprehensive Hospitals in Sichuan Province (2023 Edition). In order to guide the evaluated hospitals to comprehensively understand and master the content of hospital infection prevention and control (IPC), this article interprets the main evaluation points and scoring methods of hospital infection management in the detailed rules, emphasizes on organizational management, system implementation, monitoring/supervision, and connotation improvement for IPC. The purpose is to make the evaluated hospitals attach importance to the standardized implementation of daily work of IPC, focus on the routine, objective, and quantitative approach to accreditation work, and continuously achieve the effect of quality improvement in IPC.