Improving the Quality of Pediatric Clinical Practice Guidelines in China: A Long Way to Go
Children’s health is a critical issue that has garnered increasing attention worldwide. It is also a key indicator of a country’s social progress and economic development. In China, the field of pediatrics faces significant challenges, including a stark imbalance between medical resources and healthcare needs, as well as uneven development across different regions. Clinical practice guidelines (CPGs) play a vital role in addressing these issues by standardizing medical practices, promoting the rational and efficient use of resources, and improving the quality of healthcare services. However, the methodological quality of some CPGs in China has been found to be inadequate. This paper investigates the current status of pediatric CPGs in China and evaluates their methodological quality using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. The study aims to provide insights and recommendations for improving the development and implementation of high-quality pediatric CPGs in China.
The study systematically searched multiple databases, including the Chinese BioMedical Literature Database, Chinese National Knowledge Infrastructure, Wanfang Database, and China Science and Technology Journal Database. Additionally, the Baidu Scholar and Google Scholar search engines were used to identify relevant CPGs. The search terms included “clinical practice guideline,” “adolescent,” “children,” “pediatric,” “guideline,” “guidance,” “recommendation,” and “consensus.” A total of 4,820 records were retrieved, and after screening, 44 CPGs that met the inclusion criteria were selected for evaluation.
The AGREE II instrument was employed to assess the methodological quality of the included CPGs. This tool consists of 23 key items grouped into six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Each item was scored on a scale of 1 to 7, with 1 indicating “strongly disagree” and 7 indicating “strongly agree.” The scores for each domain were calculated by summing the scores of its items and then standardizing them.
The results of the AGREE II evaluation revealed significant variations in the quality of pediatric CPGs across different domains. The scores for stakeholder involvement, rigor of development, and applicability were particularly low, with all three domains scoring below 50%. This indicates that many CPGs did not adequately involve relevant stakeholders, lacked rigorous development processes, and failed to address practical implementation issues. Additionally, the study found that most CPGs did not consider the preferences and values of patients and their guardians during the development process. Furthermore, there was a lack of transparency in reporting specific duties, affiliations, and regional information of the participants involved in CPG development.
The study also highlighted differences in CPG quality based on their characteristics, such as type, formulating institutions, and category. For instance, CPGs focused on diagnosis and treatment scored higher in the scope and purpose domain (76.3%) compared to those focused on technology (46.3%). Similarly, CPGs developed by professional societies scored higher in stakeholder involvement (42.7%) compared to those developed by committees (7.45%). Traditional Chinese medicine (TCM) CPGs generally scored higher across multiple domains compared to Western medicine CPGs. For example, TCM CPGs scored 80.8% in scope and purpose, while Western medicine CPGs scored 59.4%.
Despite these variations, the overall methodological quality of pediatric CPGs in China was found to be inadequate. The study identified several areas for improvement. First, greater attention should be paid to the methodological and reporting quality of CPGs. The development of CPGs is a rigorous and systematic process that requires adherence to established norms and standards. The lack of standardized reporting was identified as a critical issue that needs to be addressed. Second, enhancing organizational cooperation is essential for improving CPG quality. Collaboration among different disciplines and institutions can help integrate resources and expertise, leading to more comprehensive and reliable guidelines. Additionally, increased funding is necessary to support the practical application and promotion of CPGs.
The study also emphasized the importance of basing CPGs on systematic reviews and evidence-based practices. High-quality CPGs should balance the advantages and disadvantages of alternative interventions and consider the preferences of patients and their guardians. The development process should be transparent, and efforts should be made to minimize bias and conflicts of interest. Furthermore, CPGs should be updated regularly to incorporate new evidence and ensure their relevance and accuracy.
In conclusion, the methodological quality of pediatric CPGs in China needs significant improvement. The findings of this study provide valuable insights and recommendations for guideline developers and users. By adopting international standards, enhancing organizational cooperation, and focusing on evidence-based practices, China can develop high-quality pediatric CPGs that effectively address the healthcare needs of children and contribute to the overall improvement of healthcare services.
doi.org/10.1097/CM9.0000000000001747
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