醫學指南（medical guidelines）也稱為臨床指南（clinical guideline）或是臨床實踐指南 （clinical practice guideline） ，是目的在提供醫療決策及準則指南的文件，會針對醫療保健特定領域中的診斷、管理及治療進行說明。在医学史中，幾千年前就有類似醫學指南的文件，不過以往的醫學指南是以傳統或是權威為基礎，現代的醫學指南是依循证医学的范式，以現有實證的检查為基礎。醫學指南一般會包括經過整理醫學共識或是醫療保健上的最佳實踐。醫療保健人員必須瞭解其專業科別中的醫學指南，在個別治療時則需依個別情形，決定是否依照醫學指南的建議進行。
Guidelines are usually produced at national or international levels by medical associations or governmental bodies, such as the United States Agency for Healthcare Research and Quality. Local healthcare providers may produce their own set of guidelines or adapt them from existing top-level guidelines. Healthcare payers such as insurers practicing utilization management also publish guidelines.
Special 软件 packages known as guideline execution engines have been developed to facilitate the use of medical guidelines in concert with an 電子健康紀錄 system. The Guideline Interchange Format (GLIF) is a computer representation format for clinical guidelines that can be used with such engines.
The USA and other countries maintain medical guideline clearinghouses. In the USA, the National Guideline Clearinghouse maintains a catalog of high-quality guidelines published by various health and medical associations. In the United Kingdom, clinical practice guidelines are published primarily by the National Institute for Health and Care Excellence (NICE). In The Netherlands, two bodies—the Centraal BegeleidingsOrgaan (CBO) and Nederlands Huisartsen Genootschap (NHG)—have published specialist and primary care guidelines, respectively. In Germany, the German Agency for Quality in Medicine (ÄZQ) coordinates a national program for disease management guidelines. All these organisations are now members of the Guidelines International Network (G-I-N), an international network of organisations and individuals involved in clinical practice guidelines.
Checklists have been used in medical practice to attempt to ensure that clinical practice guidelines are followed. An example is the Surgical Safety Checklist developed for the 世界卫生组织 by Dr. 阿图·葛文德. According to a meta-analysis after introduction of the checklist mortality dropped by 23% and all complications by 40%, but further high-quality studies are required to make the meta-analysis more robust. In the UK, a study on the implementation of a checklist for provision of medical care to elderly patients admitting to hospital found that the checklist highlighted limitations with frailty assessment in acute care and motivated teams to review routine practices, but that work is needed to understand whether and how checklists can be embedded in complex multidisciplinary care.
Guidelines may lose their clinical relevance as they age and newer research emerges. Even 20% of strong recommendations, especially when based on opinion rather than trials, from practice guidelines may be retracted.
纽约时报 reported in 2004 that some simple clinical practice guidelines are not routinely followed to the extent they might be. It has been found that providing a 护理学 or other medical assistant with a checklist of recommended procedures can result in the attending physician being reminded in a timely manner regarding procedures that might have been overlooked.
Guidelines may have both methodological problems and conflict of interest. As such, the quality of guidelines may vary substantially, especially for guidelines that are published on-line and have not had to follow methodological reporting standards often required by reputable clearinghouses.
Guidelines may make recommendations that are stronger than the supporting evidence.
In response to many of these problems with traditional guidelines, the BMJ created a new series of trustworthy guidelines focused on the most pressing medical issues called BMJ Rapid Recommendations.
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