Interpretation of the ecosystem of health decision making: from fragmentation to synergy_Chinese Journal of Evidence-Based Medicine

Authors：

NIAN Tao ^1,2,3 , WANG Ziyi ^1,2,3 , WANG Yongsheng ^1,2,3 , Deng Xiyuan ^2,3 , LI Yanfei ^2,3 , Wei Zhipeng ^2,3 , LI Meixuan ^2,3 ,  LI Xiuxia ^1,2,3 ,  YANG Kehu ^2,3

1. Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou 730000, P. R. China;
2. Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, P. R. China;
3. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding author：

LI Xiuxia, Email: lixiuxia@lzu.edu.cn; YANG Kehu, Email: kehuyangebm2006@126.com

Keywords：

Health decision making; Decision-making criteria; Across disciplines; Evidence-to-decision; Policy making

DOI：

10.7507/1672-2531.202207085

Video：

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In order to promote the harmonization of decision-making processes in public health and the harmonization of decision-making criteria, McMaster University in Canada and the Estonian Health Insurance Fund jointly published an article on an evidence ecosystem for health decision-making in 2022 with the support of the World Health Organization. Based on the proposed health decision-making evidence ecosystem model of the article, this paper interpreted the processes and elements in the model, aiming to provide reference for evidence-based public health decision making in China.

Citation： NIAN Tao, WANG Ziyi, WANG Yongsheng, Deng Xiyuan, LI Yanfei, Wei Zhipeng, LI Meixuan, LI Xiuxia, YANG Kehu. Interpretation of the ecosystem of health decision making: from fragmentation to synergy. Chinese Journal of Evidence-Based Medicine, 2023, 23(1): 105-111. doi: 10.7507/1672-2531.202207085 Copy

1.	毛静馥, 苏华. 从应对SARS看公共卫生决策的影响因素. 中国公共卫生管理, 2004, 20(2): 102-104.
2.	高琦, 王娜, 姜宝法. 循证卫生决策网络及其研究进展. 中国卫生事业管理, 2007, 23(10): 659-661.
3.	王娜, 姜宝法. 循证公共卫生决策的发展现状及其前景. 中国公共卫生, 2006, 22(10): 1272-1274.
4.	Schünemann HJ, Reinap M, Piggott T, et al. The ecosystem of health decision making: from fragmentation to synergy. Lancet Public Health, 2022, 7(4): e378-e390.
5.	Richardson WS, Wilson MC, Nishikawa J, et al. The well-built clinical question: a key to evidence-based decisions. ACP, 1995, 123(3): A12-A13.
6.	李秀霞, 陈耀龙, 王小琴, 等. 通过改进挽留政策提高农村和边远地区卫生人力的可及性: WHO 2010全球政策建议解读. 中国循证医学杂志, 2013, 13(9): 1037-1042.
7.	Schünemann HJ, Santesso N, Vist GE, et al. Using GRADE in situations of emergencies and urgencies: certainty in evidence and recommendations matters during the COVID-19 pandemic, now more than ever and no matter what. J Clin Epidemiol, 2020, 127: 202-207.
8.	李幼平, 王莉. 卫生技术评估与卫生决策. 中国循证医学, 2001, 1(2): 67-70.
9.	逄征虎. GB/T1. 1-2000《标准化工作导则第1部分:标准的结构和编写规则》介绍. 中国个体防护装备, 2001, (5): 30-32.
10.	The GRADE working group. What is GRADE? Available at: http://www.gradeworkinggroup.org.
11.	Moberg J, Oxman AD, Rosenbaum S, et al. The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst, 2018, 16(1): 45.
12.	Nussbaumer-Streit B, Grillich L, Glechner A, et al. GRADE: Evidence to Decision (EtD) frameworks - a systematic and transparent approach to making well informed healthcare choices. 1:Introduction. Z Evid Fortbild Qual Gesundhwes, 2018, 134: 57-66.
13.	Bertram MY, Lauer JA, De Joncheere K, et al. Cost-effectiveness thresholds: pros and cons. Bull World Health Organ, 2016, 94(12): 925-930.
14.	Lomas JRS. Incorporating Affordability concerns within cost-effectiveness analysis for health technology assessment. Value Health, 2019, 22(8): 898-905.
15.	O'Rourke B, Oortwijn W, Schuller T, et al. The new definition of health technology assessment: a milestone in international collaboration. Int J Technol Assess Health Care, 2020, 36(3): 187-190.
16.	Velasco-Garrido M, Zentner A, Busse R. Health systems health policy and health technology assessment. In: European Observatory, editor. Health technology assessment and health policy-making in Europe - Current status, challenges and potential. Copenhagen: World Health Organization, 2008: 53-78.
17.	Fischer KE. A systematic review of coverage decision-making on health technologies-evidence from the real world. Health Policy, 2012, 107(2-3): 218-230.
18.	Peacocke EF, Myhre SL, Foss HS, et al. National adaptation and implementation of WHO model list of essential medicines: a qualitative evidence synthesis. PLoS Med, 2022, 19(3): e1003944.
19.	Agency for healthcare research and quality. Choosing quality measures. Available at: https://www.ahrq.gov/patientsafety/quality/resources/tools/chtoolbx/choosing/index.html.
20.	Davies P. Is evidence-based government possible? Available at: www. policyhub. gov. uk/downloads/JerryLeeLecture 1202041.
21.	Kunz R, Djulbegovic B, Schunemann HJ, et al. Misconceptions, challenges, uncertainty, and progress in guideline recommendations. Semin Hematol, 2008, 45(3): 167-175.
22.	Frazão TDC, Camilo DGG, Cabral ELS, et al. Multicriteria decision analysis (MCDA) in health care: a systematic review of the main characteristics and methodological steps. BMC Med Inform Decis Mak, 2018, 18(1): 90.
23.	Brozek JL, Canelo-Aybar C, Akl EA, et al. GRADE Guidelines 30: the GRADE approach to assessing the certainty of modeled evidence-An overview in the context of health decision-making. J Clin Epidemiol, 2021, 129: 138-150.
24.	Wahlster P, Goetghebeur M, Kriza C, et al. Balancing costs and benefits at different stages of medical innovation: a systematic review of Multi-criteria decision analysis (MCDA). BMC Health Serv Res, 2015, 15: 262.
25.	Massetti M, Aballéa S, Videau Y, et al. A comparison of HAS & NICE guidelines for the economic evaluation of health technologies in the context of their respective national health care systems and cultural environments. J Mark Access Health Policy, 2015, 12: 3.
26.	Santesso N, Mustafa RA, Schünemann HJ, et al. World health organization guidelines for treatment of cervical intraepithelial neoplasia 2-3 and screen-and-treat strategies to prevent cervical cancer. Int J Gynaecol Obstet, 2016, 132(3): 252-258.
27.	Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science, 1981, 211(4481): 453-458.
28.	Schünemann HJ, Mustafa RA, Brozek J, et al. GRADE guidelines: 22. The GRADE approach for tests and strategies-from test accuracy to patient-important outcomes and recommendations. J Clin Epidemiol, 2019, 111: 69-82.
29.	Lotfi T, Hajizadeh A, Moja L, et al. A taxonomy and framework for identifying and developing actionable statements in guidelines suggests avoiding informal recommendations. J Clin Epidemiol, 2022, 141: 161-171.
30.	Ciociola AA, Karlstadt RG, Pambianco DJ, et al. The food and drug administration advisory committees and panels: how they are applied to the drug regulatory process. Am J Gastroenterol, 2014, 109(10): 1508-1512.
31.	Mazzariol B, Karaboue M, Di Luca A, et al. Guidelines, good practices and best clinical health practices: valuable guidance for physicians and judges. Clin Ter, 2018, 169(6): e292-e296.
32.	陈英耀, 刘文彬, 唐檬, 等. 我国卫生技术评估与决策转化研究概述. 中国卫生政策研究, 2013, 6(7): 1-6.
33.	Cheuk DK, Wong V, Chen WX. Acupuncture for autism spectrum disorders (ASD). Cochrane Database Syst Rev, 2011, (9): CD007849.
34.	唐智柳, 陈英耀. 对我国卫生技术管理的若干思考. 中国卫生资源, 2007, 10(4): 178-179.
35.	Chen Y, Schweitzer SO. Issues in drug pricing, reimbursement, and access in China with references to other Asia-Pacific region. Value Health, 2008, 11(Suppl 1): S124-S129.
36.	陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进. 中国循证医学杂志, 2008, 8(2): 127-133.
37.	Atkins D, Eccles M, Flottorp S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res, 2004, 4(1): 38.
38.	卢姝亚, 赵思雅, 吴守媛, 等. 2019年期刊公开发表的中国临床实践指南文献调查与评价—证据质量和推荐强度. 协和医学杂志, 2022, 13(1): 130-137.
39.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
40.	Nußbaumer B, Gartlehner G, Kien C, et al. GRADE guidelines 15: going from evidence to recommendation - determinants of a recommendation's direction and strength. Z Evid Fortbild Qual Gesundhwes, 2014, 108(7): 421-431.
41.	Colpani V, Kowalski SC, Stein AT, et al. Clinical practice guidelines in Brazil - developing a national programme. Health Res Policy Syst, 2020, 18(1): 69.

1. 毛静馥, 苏华. 从应对SARS看公共卫生决策的影响因素. 中国公共卫生管理, 2004, 20(2): 102-104.
2. 高琦, 王娜, 姜宝法. 循证卫生决策网络及其研究进展. 中国卫生事业管理, 2007, 23(10): 659-661.
3. 王娜, 姜宝法. 循证公共卫生决策的发展现状及其前景. 中国公共卫生, 2006, 22(10): 1272-1274.
4. Schünemann HJ, Reinap M, Piggott T, et al. The ecosystem of health decision making: from fragmentation to synergy. Lancet Public Health, 2022, 7(4): e378-e390.
5. Richardson WS, Wilson MC, Nishikawa J, et al. The well-built clinical question: a key to evidence-based decisions. ACP, 1995, 123(3): A12-A13.
6. 李秀霞, 陈耀龙, 王小琴, 等. 通过改进挽留政策提高农村和边远地区卫生人力的可及性: WHO 2010全球政策建议解读. 中国循证医学杂志, 2013, 13(9): 1037-1042.
7. Schünemann HJ, Santesso N, Vist GE, et al. Using GRADE in situations of emergencies and urgencies: certainty in evidence and recommendations matters during the COVID-19 pandemic, now more than ever and no matter what. J Clin Epidemiol, 2020, 127: 202-207.
8. 李幼平, 王莉. 卫生技术评估与卫生决策. 中国循证医学, 2001, 1(2): 67-70.
9. 逄征虎. GB/T1. 1-2000《标准化工作导则第1部分:标准的结构和编写规则》介绍. 中国个体防护装备, 2001, (5): 30-32.
10. The GRADE working group. What is GRADE? Available at: http://www.gradeworkinggroup.org.
11. Moberg J, Oxman AD, Rosenbaum S, et al. The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst, 2018, 16(1): 45.
12. Nussbaumer-Streit B, Grillich L, Glechner A, et al. GRADE: Evidence to Decision (EtD) frameworks - a systematic and transparent approach to making well informed healthcare choices. 1:Introduction. Z Evid Fortbild Qual Gesundhwes, 2018, 134: 57-66.
13. Bertram MY, Lauer JA, De Joncheere K, et al. Cost-effectiveness thresholds: pros and cons. Bull World Health Organ, 2016, 94(12): 925-930.
14. Lomas JRS. Incorporating Affordability concerns within cost-effectiveness analysis for health technology assessment. Value Health, 2019, 22(8): 898-905.
15. O'Rourke B, Oortwijn W, Schuller T, et al. The new definition of health technology assessment: a milestone in international collaboration. Int J Technol Assess Health Care, 2020, 36(3): 187-190.
16. Velasco-Garrido M, Zentner A, Busse R. Health systems health policy and health technology assessment. In: European Observatory, editor. Health technology assessment and health policy-making in Europe - Current status, challenges and potential. Copenhagen: World Health Organization, 2008: 53-78.
17. Fischer KE. A systematic review of coverage decision-making on health technologies-evidence from the real world. Health Policy, 2012, 107(2-3): 218-230.
18. Peacocke EF, Myhre SL, Foss HS, et al. National adaptation and implementation of WHO model list of essential medicines: a qualitative evidence synthesis. PLoS Med, 2022, 19(3): e1003944.
19. Agency for healthcare research and quality. Choosing quality measures. Available at: https://www.ahrq.gov/patientsafety/quality/resources/tools/chtoolbx/choosing/index.html.
20. Davies P. Is evidence-based government possible? Available at: www. policyhub. gov. uk/downloads/JerryLeeLecture 1202041.
21. Kunz R, Djulbegovic B, Schunemann HJ, et al. Misconceptions, challenges, uncertainty, and progress in guideline recommendations. Semin Hematol, 2008, 45(3): 167-175.
22. Frazão TDC, Camilo DGG, Cabral ELS, et al. Multicriteria decision analysis (MCDA) in health care: a systematic review of the main characteristics and methodological steps. BMC Med Inform Decis Mak, 2018, 18(1): 90.
23. Brozek JL, Canelo-Aybar C, Akl EA, et al. GRADE Guidelines 30: the GRADE approach to assessing the certainty of modeled evidence-An overview in the context of health decision-making. J Clin Epidemiol, 2021, 129: 138-150.
24. Wahlster P, Goetghebeur M, Kriza C, et al. Balancing costs and benefits at different stages of medical innovation: a systematic review of Multi-criteria decision analysis (MCDA). BMC Health Serv Res, 2015, 15: 262.
25. Massetti M, Aballéa S, Videau Y, et al. A comparison of HAS & NICE guidelines for the economic evaluation of health technologies in the context of their respective national health care systems and cultural environments. J Mark Access Health Policy, 2015, 12: 3.
26. Santesso N, Mustafa RA, Schünemann HJ, et al. World health organization guidelines for treatment of cervical intraepithelial neoplasia 2-3 and screen-and-treat strategies to prevent cervical cancer. Int J Gynaecol Obstet, 2016, 132(3): 252-258.
27. Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science, 1981, 211(4481): 453-458.
28. Schünemann HJ, Mustafa RA, Brozek J, et al. GRADE guidelines: 22. The GRADE approach for tests and strategies-from test accuracy to patient-important outcomes and recommendations. J Clin Epidemiol, 2019, 111: 69-82.
29. Lotfi T, Hajizadeh A, Moja L, et al. A taxonomy and framework for identifying and developing actionable statements in guidelines suggests avoiding informal recommendations. J Clin Epidemiol, 2022, 141: 161-171.
30. Ciociola AA, Karlstadt RG, Pambianco DJ, et al. The food and drug administration advisory committees and panels: how they are applied to the drug regulatory process. Am J Gastroenterol, 2014, 109(10): 1508-1512.
31. Mazzariol B, Karaboue M, Di Luca A, et al. Guidelines, good practices and best clinical health practices: valuable guidance for physicians and judges. Clin Ter, 2018, 169(6): e292-e296.
32. 陈英耀, 刘文彬, 唐檬, 等. 我国卫生技术评估与决策转化研究概述. 中国卫生政策研究, 2013, 6(7): 1-6.
33. Cheuk DK, Wong V, Chen WX. Acupuncture for autism spectrum disorders (ASD). Cochrane Database Syst Rev, 2011, (9): CD007849.
34. 唐智柳, 陈英耀. 对我国卫生技术管理的若干思考. 中国卫生资源, 2007, 10(4): 178-179.
35. Chen Y, Schweitzer SO. Issues in drug pricing, reimbursement, and access in China with references to other Asia-Pacific region. Value Health, 2008, 11(Suppl 1): S124-S129.
36. 陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进. 中国循证医学杂志, 2008, 8(2): 127-133.
37. Atkins D, Eccles M, Flottorp S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res, 2004, 4(1): 38.
38. 卢姝亚, 赵思雅, 吴守媛, 等. 2019年期刊公开发表的中国临床实践指南文献调查与评价—证据质量和推荐强度. 协和医学杂志, 2022, 13(1): 130-137.
39. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
40. Nußbaumer B, Gartlehner G, Kien C, et al. GRADE guidelines 15: going from evidence to recommendation - determinants of a recommendation's direction and strength. Z Evid Fortbild Qual Gesundhwes, 2014, 108(7): 421-431.
41. Colpani V, Kowalski SC, Stein AT, et al. Clinical practice guidelines in Brazil - developing a national programme. Health Res Policy Syst, 2020, 18(1): 69.

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