作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Design and Thought for Establishing Decision Trees Based on Clinical Practice Guidelines
-
摘要: 临床实践指南可以促进临床诊疗规范化，提高医疗服务质量。但是，指南在传播与实施过程中可能存在多种障碍因素，导致其对临床实践的规范性及患者结局的有效性并未完全体现。主要障碍在于非结构化的文本指南不便于临床医生查阅和使用，阻碍了指南在临床实践中的应用。因此，本文通过介绍决策树模型，阐述将文本化的指南转化为结构化决策树的方法，提出基于临床实践指南设计决策树的优点、难点及解决策略，为推动文本化临床实践指南的转化提供参考。Abstract: Clinical practice guidelines can facilitate the standardization of the diagnosis and treatment and improve health care quality. However, there are barriers to guideline dissemination and implementation, thus impeding the standardization of clinical practice and improvement of patient outcomes. One major barrier is that it is difficult for doctors to read and understand the unstructured text-based guidelines, and apply them in real clinical practice. This paper introduces the design of decision trees based on clinical practice guidelines, and the advantages, challenges and solutions of this approach, with the hope of providing references for promoting the transformation of textual clinical practice guidelines.
-
Key words:
- clinical practice guideline /
- implementation /
- decision tree
作者贡献：申泉负责系统查阅文献资源、撰写初稿；罗旭飞、石安娅、雷若冰、吕萌、侯天春负责查阅部分文献、修改初稿；张姝、刘恩梅、李秋负责设计文章结构、修改初稿；陈耀龙负责论文选题、结构设计及修订。利益冲突：所有作者均声明不存在利益冲突 -
[1] Institute of Medicine(US). Clinical practice guidelines we can trust[M]. Washington(DC): National Academies Press, 2011: 15. [2] 吴梦佳, 张士靖, 周志超, 等. 我国临床实践指南利用和需求调查[J]. 中华医学图书情报杂志, 2016, 25: 37-42. https://www.cnki.com.cn/Article/CJFDTOTAL-YXTS201601009.htm [3] Runnacles J, Roueche A, Lachman P. The right care, every time: improving adherence to evidence-based guidelines[J]. Arch Dis Child Educ Pract Ed, 2018, 103: 27-33. doi: 10.1136/archdischild-2017-312740 [4] Liu M, Zhang C, Zha Q, et al. A national survey of Chinese medicine doctors and clinical practice guidelines in China[J]. BMC Complement Altern Med, 2017, 17: 451. doi: 10.1186/s12906-017-1946-2 [5] Hussain M, Hussain J, Ali T, et al. Text classification in clinical practice guidelines using machine-learning assisted pattern-based approach[J]. Appl Sci, 2021, 11: 3296. doi: 10.3390/app11083296 [6] 刘国恩. 中国药物经济学评价指南及导图: 2015版[M]. 北京: 科学出版社, 2015. [7] Keikes L, Kos M, Verbeek XAAM, et al. Conversion of a colorectal cancer guideline into clinical decision trees with assessment of validity[J]. Int J Qual Health Care, 2021, 33: mzab051. doi: 10.1093/intqhc/mzab051 [8] 张敏, 陆向艳, 周敏, 等. 数据挖掘在智能题库系统中的应用[J]. 广西大学学报(自然科学版), 2005(S2): 24-25. https://www.cnki.com.cn/Article/CJFDTOTAL-GXKZ2005S2008.htm [9] 张奇, 荣雯雯, 刘艳. 基因表达谱数据分类算法综述[J]. 实用预防医学, 2018, 25: 1018-1022. doi: 10.3969/j.issn.1006-3110.2018.08.035 [10] Netherlands Comprehensive Cancer Organisation(IKNL). Oncoguide FAQ[EB/OL]. (2021-08-06)[2022-06-10]. https://www.oncoguide.nl/#!/projects. [11] 杨艳. 基于临床指南的临床决策支持系统的设计与实现[D]. 杭州: 浙江工业大学, 2009. [12] Hendriks MP, Verbeek XAAM, van Vegchel T, et al. Transformation of the national breast cancer guideline into data-driven clinical decision trees[J]. JCO Clin Cancer Inform, 2019, 3: 1-14. [13] 中华医学会儿科学分会免疫学组, 中华儿科杂志编辑委员会. 中国儿童系统性红斑狼疮诊断与治疗指南[J]. 中华儿科杂志, 2021, 59: 1009-1024. doi: 10.3760/cma.j.cn112140-20210905-00743 [14] 郝惠娟, 杨喆, 刘丹红. 基于信息模型的本地医学术语与SNOMED CT的映射方法探索[J]. 中国数字医学, 2019, 14: 29-32. https://www.cnki.com.cn/Article/CJFDTOTAL-YISZ201904012.htm [15] 国家卫生与健康委员会. 国际疾病分类第十一次修订本(ICD-11)中文版[EB/OL]. (2018-12-14)[2022-06-10]. http://www.nhc.gov.cn/yzygj/s7659/201812/14caf755107c43d2881905a8d4f44ed2.shtml. [16] 周群一, 田慧, 杨艳, 等. 基于临床指南的临床决策支持系统[C]. 中华医院信息网络大会暨第四届中美医院信息化论坛论文集, 2008: 448-457. [17] National Borstkanker Overleg Nederland. Breast Cancer: Dutch Guideline, Version 2.0[EB/OL]. (2012-02)[2022-06-10]. http://www.oncoline.nl/breastcancer. [18] Liu E, Smyth RL, Luo Z, et al. Rapid advice guidelines for management of children with COVID-19[J]. Ann Transl Med, 2020, 8: 617. doi: 10.21037/atm-20-3754 [19] 国家卫生健康委员会. 国家卫生健康委关于新型冠状病毒肺炎暂命名事宜的通知[EB/OL]. (2020-02-08)[2021-06-09]. http://www.nhc.gov.cn/yzygj/s7653p/202002/18c1bb43965a4492907957875de02ae7.shtml. [20] Djulbegovic B, Hozo I, Dale W. Transforming clinical practice guidelines and clinical pathways into fast-and-frugal decision trees to improve clinical care strategies[J]. J Eval Clin Pract, 2018, 24: 1247-1254. doi: 10.1111/jep.12895 [21] Luo Y, Wu H, Liao X, et al. A guideline-based decision tree achieves better glucose control with less hypoglycemia at 3 months in Chinese diabetic patients[J]. Diabetes Ther, 2021, 12: 1887-1899. [22] van Oijen MG, Verbeek XA, van Vegchel T, et al. Improving visualization and adherence by converting the Dutch colorectal cancer guidelines into decision trees: the Oncoguide project[J]. Ann Oncol, 2017, 28: v203-v204. [23] 林夏, 杨克虎, 陈耀龙, 等. 中国临床实践指南的现状与思考[J]. 中国循证医学杂志, 2017, 17: 497-500. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXZ201705001.htm -
下载:
点击查看大图
图(3)
计量
- 文章访问数: 412
- HTML全文浏览量: 58
- PDF下载量: 78
- 被引次数: 0
