【摘要】 目的通过实证研究评价《中国肾移植排斥反应临床诊疗指南》(以下简称"肾移植指南")的适用性,建立指南临床适用性评价的数据分析和结果报告模型,为指南的临床适用性评价和更新提供参考依据。方法采用横断面调查方法,调查国内已开展肾移植工作的医疗机构16家,每家医疗机构抽取肾移植科或相关科室医生6～8人填写指南适用性评价问卷。描述性分析调查对象基本特征、各维度评分、指南获取途径等。采用Kruskal-Wallis秩和检验和Nemenyi检验进行多组比较和两两比较,采用多重线性回归方法并结合逐步回归模型筛选出各评分的影响因素。结果本次调查发放了128份问卷,共收集有效问卷105份,有效回收率82.03%。本次调查对象均为公立三级医院从事肾移植专业的医生,平均工作年限为10.95年。评分结果显示,该指南可获得性评分最低,可接受性评分最高。多组比较和多重线性回归分析结果显示,专科医生对指南熟悉程度是各评分的影响因素(P<0.05)。专科医生指南获取途径主要为生物医学文献数据库(73.3%),专业学术期刊(55.2%),学术会议(55.2%)。认为指南存在实施障碍的专科医生有44名(41.9%),认为实施障碍为环境因素的有40名(38.1%)。结论肾移植指南整体适用性评价结果较好,但该指南在宣传和推广方面仍有待提高。建议指南更新时可考虑在指南中加入获取指南的途径,增加免费公共信息推广,通过指南培训项目,使临床医生熟悉指南内容,从而促进指南的普及、推广和应用。更多还原

【Abstract】 Objectives To establish statistical analysis and result reporting model for evaluation of the applicability of the clinical guidelines. We conducted empirical study for clinical guidelines for diagnosis and treatment of renal transplantation rejection in China. Methods A cross-sectional survey was conducted to select 16 medical institutions in China which had carried out kidney transplantations. In each medical institution, 6 to 8 clinicians from the kidney transplantation department or related departments were selected to complete the questionnaire. Descriptive analysis was carried out for characteristics of evaluators, scores of each dimension, access to guidelines and factors affecting implementation. The Kruskal-Wallis rank sum test and Nemenyi test were used for multi-group comparison and pairwise comparison. Multiple linear regression with stepwise strategy were used to screen out the association factors.Results In this survey, 128 questionnaires were distributed, in which 105 valid questionnaires were collected, and the recovery rate was 82.03%. The subjects of this survey were all kidney transplant clinicians from public tertiary hospitals, with an average 10.95 years of working time. The results showed the accessibility score was lowest and the acceptability score was highest. The results of multi-group comparison and multiple linear regression analysis showed that familiarity with the guidelines was the influencing factor of each score(P<0.05). The guidelines were primarily obtained from biomedical literature database(73.3%), academic journals(55.2%) and academic conferences(55.2%). Among the evaluators, 44(41.9%) believed that there were implementation obstacles in the guidelines, among which 40(38.1%) believed that implementation obstacles were environmental factors. Conclusions The applicability of clinical guidelines for diagnosis and treatment of renal transplantation rejection in China is adequate. However, the publicity of the guideline requires improvement. As the guideline is updated, consideration should be given to including access to the guideline, adding free public information promotion, and familiarizing clinicians with the guidelines through training programs to promote application of the guideline.更多还原