美国西北大学Murad Alam团队研究了美国联合委员会医院认证标准的证据基础。相关论文于2022年6月23日发表在《英国医学杂志》上。
为了评估医疗机构认证联合委员会（联合委员会）制定医院认证标准的依据，研究组在美国进行了一项横断面研究。四份联合委员会R3（要求、理由和参考）报告于2018年7月发布，计划于2018年7月1日至2019年7月1日生效。
从每个R3报告中提取相关标准及其具体绩效要素（或可操作标准）。如果一个可操作的标准列举了多个需求，则这些需求被划分为不同的组件。两名研究人员审查了全文参考文献，每个可操作的标准被分类为完全支持、部分支持或不支持；采用牛津证据质量评分进行评级；而建议的分级、测评、开发和评估（GRADE）被用来评估建议的优势。主要观察指标为可操作标准建议的优势。
20个可操作标准有76个不同的组成部分，附有48个参考文献。在20项可操作标准中，有6项（30%）完全得到引用参考文献的支持，6项（30%）部分得到支持，8项（40%）不被支持。
在6个直接被支持的可操作标准中，1个（17%）引用了至少一个1级或2级证据的参考文献，没有标准引用至少一个3级证据的参考文献，5个（83%）引用了4级或5级证据的参考文献。在完全支持的可操作标准中，有5项被视为D级，1项被视为B级。
研究结果表明，一般来说，联合委员会发布的最新可执行标准很少得到发布文件中引用的高质量数据的支持。联合委员会可考虑在证据质量和支持其每项建议的基本理由方面更加透明，包括澄清在某些情况下，联合委员会何时以及为什么确定较低级别的证据是充分的。
附：英文原文
Title: The evidence base for US joint commission hospital accreditation standards: cross sectional study
Author: Sarah A Ibrahim, Kelly A Reynolds, Emily Poon, Murad Alam
Issue&Volume: 2022/06/23
Abstract:
Objective To evaluate the evidence upon which standards for hospital accreditation by The Joint Commission on Accreditation of Healthcare Organizations (the Joint Commission) are based.
Design Cross sectional study.
Setting United States.
Participants Four Joint Commission R3 (requirement, rationale, and reference) reports released by July 2018 and intended to become effective between 1 July 2018 and 1 July 2019.
Interventions From each R3 report the associated standard and its specific elements of performance (or actionable standards) were extracted. If an actionable standard enumerated multiple requirements, these were separated into distinct components. Two investigators reviewed full text references, and each actionable standard was classified as either completely supported, partly supported, or not supported; Oxford evidence quality ratings were assigned; and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the strength of recommendations.
Main outcome measure Strengths of recommendation for actionable standards.
Results 20 actionable standards with 76 distinct components were accompanied by 48 references. Of the 20 actionable standards, six (30%) were completely supported by cited references, six were partly supported (30%), and eight (40%) were not supported. Of the six directly supported actionable standards, one (17%) cited at least one reference of level 1 or 2 evidence, none cited at least one reference of level 3 evidence, and five (83%) cited references of level 4 or 5 evidence. Of the completely supported actionable standards, strength of recommendation in five was deemed GRADE D and in one was GRADE B.
Conclusions In general, recent actionable standards issued by The Joint Commission are seldom supported by high quality data referenced within the issuing documents. The Joint Commission might consider being more transparent about the quality of evidence and underlying rationale supporting each of its recommendations, including clarifying when and why in certain instances it determines that lower level evidence is sufficient.
DOI: 10.1136/bmj-2020-063064
Source: https://www.bmj.com/content/377/bmj-2020-063064
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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本期文章：《英国医学杂志》：Online/在线发表
