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The quality of clinical practice guidelines in China: a systematic assessment

Authors

  • Jing Hu MD PhD,

    1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
    2. Evidence-Based Medicine Center, Peking University, Beijing, China
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  • Ru Chen MD,

    1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
    2. Evidence-Based Medicine Center, Peking University, Beijing, China
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  • Shanshan Wu MS,

    1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
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  • Jinling Tang PhD,

    Director
    1. Hong Kong Cochrane Centre, School of Public Health, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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  • Gillian Leng MD,

    Deputy Chief Executive
    1. National Institute for Health and Clinical Excellence, London, UK
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  • Ilkka Kunnamo MD PhD,

    Adjunct Professor
    1. The Finnish Medical Society Duodecim, Helsinki, Finland
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  • Zhirong Yang MS,

    1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
    2. Evidence-Based Medicine Center, Peking University, Beijing, China
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  • Weiwei Wang MS,

    1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
    2. Evidence-Based Medicine Center, Peking University, Beijing, China
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  • Xinyang Hua MS,

    1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
    2. Evidence-Based Medicine Center, Peking University, Beijing, China
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  • Yuelun Zhang MS,

    1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
    2. Evidence-Based Medicine Center, Peking University, Beijing, China
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  • Yanming Xie MS,

    Deputy Director
    1. Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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  • Siyan Zhan MD PhD

    Corresponding author
    1. Evidence-Based Medicine Center, Peking University, Beijing, China
    • Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
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  • Conflict of interest: The authors have declared that no competing interests exist.

Correspondence

Prof. Siyan Zhan

Evidence-Based Medicine Center

School of Public Health

Peking University Health Science Centre

38# Xueyuan Road

Haidian District

Beijing 100191

China

E-mail: siyan-zhan@bjmu.edu.cn

Abstract

Background

Clinical guidelines are an important tool for improving service quality, the benefits of guidelines depend on their quality. In China, there has been a great increase in production of guidelines. However, little is known about their quality.

Method

We identified Chinese guidelines published between 2006 and 2010 by searching three Chinese full-text databases, major Chinese guidelines websites and Google. Three appraisers independently evaluated each guideline by using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Subgroup analyses were performed according to source, title, version, aspect of care and developer of guidelines.

Results

A total of 327 guidelines were eligible and 57 were excluded for their lacking of any account of the guideline development methodology. Of the 270 guidelines, 77 (28.5%) can be recommended, 6 (2.2%) were evidence-based guidelines. Sixteen (5.9%) guidelines described the methods used to search for evidence, 61 (22.6%) appraised the quality of evidence and 53 (19.6%) graded the strength of recommendations. Two guidelines declared the involvement of methodological experts and none reported considering patients’ values. 29 (10.7%) guidelines received drug company sponsorship but only two declared the views of the funding bodies did not influence the recommendations, 259 (95.9%) didn't declare the interest conflicts of guideline developers. Guidelines downloaded from Internet and with updated versions yielded higher quality than the rest.

Conclusions

Although numerous guidelines were produced in China, the quality was generally low. Focusing on improving the quality of Chinese guidelines, rather than continuing to produce them in great quantity, is urgently needed.

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