An empirical study on evaluation of clinical applicability of kidney transplantation guideline_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Chuan ^1,2 ^# , LI Hailong ^1,2 ^# , HUANG Chao ³ , ZENG Linan ^1,2 , HUANG Zongyao ^1,2,4 , YI Qiusha ^1,2,5 , CHEN Xiao ^1,2,4 , KANG Deying ⁶ , LIU Guanjian ⁶ , LIU Qiaolan ⁷ , ZHAO Rongsheng ^8,9 , ZHANG Junhua ¹⁰ , LI Youping ⁶ ,  WANG Qiang ³ ,  ZHANG Lingli ^1,2,9

1. Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, P.R.China;
3. Medical Management Service Guidance Center, National Health Commission of the People’s Republic of China, Beijing 10004, P.R.China;
4. West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R.China;
5. West China School of Medicine, Sichuan University, Chengdu 610041, P.R.China;
6. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
7. West China School of Public Health, Sichuan University, Chengdu 610041, P.R.China;
8. Department Pharmacy, Peking University Third Hospital, Beijing 100191, P.R.China;
9. Evidence-based Pharmacy Committee, Chinese Pharmaceutical Association, Beijing 100044, P.R.China;
10. Centre for Evidence-Based Medicine, Tianjin University of TCM, Tianjin 301617, P.R.China;

Corresponding?author：

WANG Qiang, Email: jason2019@sina.cn; ZHANG Lingli, Email: zhanglingli@scu.edu.cn

Keywords：

Kidney transplantation guideline; Applicability of guideline; Scale analysis; Influencing factor

DOI：

10.7507/1672-2531.201909125

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Objectives To establish statistical analysis and result reporting model for evaluation of the applicability of the clinical guidelines. We conducted empirical study for clinical guidelines for diagnosis and treatment of renal transplantation rejection in China.Methods A cross-sectional survey was conducted to select 16 medical institutions in China which had carried out kidney transplantations. In each medical institution, 6 to 8 clinicians from the kidney transplantation department or related departments were selected to complete the questionnaire. Descriptive analysis was carried out for characteristics of evaluators, scores of each dimension, access to guidelines and factors affecting implementation. The Kruskal-Wallis rank sum test and Nemenyi test were used for multi-group comparison and pairwise comparison. Multiple linear regression with stepwise strategy were used to screen out the association factors.Results In this survey, 128 questionnaires were distributed, in which 105 valid questionnaires were collected, and the recovery rate was 82.03%. The subjects of this survey were all kidney transplant clinicians from public tertiary hospitals, with an average 10.95 years of working time. The results showed the accessibility score was lowest and the acceptability score was highest. The results of multi-group comparison and multiple linear regression analysis showed that familiarity with the guidelines was the influencing factor of each score (P<0.05). The guidelines were primarily obtained from biomedical literature database (73.3%), academic journals (55.2%) and academic conferences (55.2%). Among the evaluators, 44 (41.9%) believed that there were implementation obstacles in the guidelines, among which 40 (38.1%) believed that implementation obstacles were environmental factors.Conclusions The applicability of clinical guidelines for diagnosis and treatment of renal transplantation rejection in China is adequate. However, the publicity of the guideline requires improvement. As the guideline is updated, consideration should be given to including access to the guideline, adding free public information promotion, and familiarizing clinicians with the guidelines through training programs to promote application of the guideline.

Citation： ZHANG Chuan, LI Hailong, HUANG Chao, ZENG Linan, HUANG Zongyao, YI Qiusha, CHEN Xiao, KANG Deying, LIU Guanjian, LIU Qiaolan, ZHAO Rongsheng, ZHANG Junhua, LI Youping, WANG Qiang, ZHANG Lingli. An empirical study on evaluation of clinical applicability of kidney transplantation guideline. Chinese Journal of Evidence-Based Medicine, 2020, 20(5): 543-550. doi: 10.7507/1672-2531.201909125 Copy

1.	Abecassis M, Bartlett ST, Collins AJ, et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol, 2008, 3(2): 471-480.
2.	Nankivell BJ, Alexander SI. Rejection of the kidney allograft. N Engl J Med, 2010, 363(15): 1451-1462.
3.	Sellarés J, de Freitas DG, Mengel M, et al. Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence. Am J Transplant, 2012, 12(2): 388-399.
4.	Wiebe C, Gibson IW, Blydt-Hansen TD, et al. Evolution and clinical pathologic correlations of de novo donor-specific HLA antibody post kidney transplant. Am J Transplant, 2012, 12(5): 1157-1167.
5.	石炳毅, 陳莉萍. 中國腎移植排斥反應臨床診療指南 (2016 版). 器官移植, 2016, (5): 332-338.
6.	Amer YS, Elzalabany MM, Omar TI, et al. The 'Adapted ADAPTE': an approach to improve utilization of the ADAPTE guideline adaptation resource toolkit in the Alexandria Center for Evidence-Based Clinical Practice Guidelines. J Eval Clin Pract, 2015, 21(6): 1095-1106.
7.	O'Donoghue KJM, Reed RD, Knight SR, et al. Systematic review of clinical practice guidelines in kidney transplantation. BJS Open, 2017, 1(4): 97-105.
8.	Tong A, Chapman JR, Wong G, et al. Screening and follow-up of living kidney donors: a systematic review of clinical practice guidelines. Transplantation, 2011, 92(9): 962-972.
9.	Alonso-Coello P, Irfan A, Solà I, et al. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care, 2010, 19(6): e58.
10.	曾力楠, 易秋莎, 張川, 等. 制訂指南臨床適用性評價工具. 中國循證醫學雜志, 2020, DOI: 10.7507/1672-2531.201904131.
11.	Tabachnick BG, Fidell LS. Using multivariate statistics (5th edtion). New York: Allyn and Bacon, 2007.
12.	孫振球, 徐勇勇. 醫學統計學. 北京: 人民衛生出版社, 2014.
13.	Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: The RIGHT Statement. Ann Intern Med, 2017, 166(2): 128-132.
14.	中華醫學會器官移植學分會. 腎移植排斥反應臨床診療技術規范 (2019 版). 器官移植, 2019, 10(5): 505-512.
15.	汪宏, 包旭. 臨床診療指南的獲取、評價與應用. 中國執業藥師, 2012, 9(4): 47-50.
16.	Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-E842.
17.	O?Donoghue KJM, Reed RD, Knight SR, et al. Critical appraisal of international clinical practice guidelines in kidney transplantation using the appraisal of guidelines for research and education ii tool: a systematic review. Transplantation, 2018, 102(9): 1419-1439.
18.	Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant, 2009, 9(Suppl 3): S1-155.
19.	陳江華, 何強. 《KDIGO 臨床實踐指南: 腎移植受者的診治》免疫抑制部分對我們的啟示. 中華移植雜志 (電子版), 2010, (3): 178-181.
20.	王芳, 楊洋, 劉孟宇, 等. 基于指南熟悉和使用程度探索中醫診療指南實施推廣策略. 中華中醫藥雜志, 2016, 31(8): 3162-3165.

1. Abecassis M, Bartlett ST, Collins AJ, et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol, 2008, 3(2): 471-480.
2. Nankivell BJ, Alexander SI. Rejection of the kidney allograft. N Engl J Med, 2010, 363(15): 1451-1462.
3. Sellarés J, de Freitas DG, Mengel M, et al. Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence. Am J Transplant, 2012, 12(2): 388-399.
4. Wiebe C, Gibson IW, Blydt-Hansen TD, et al. Evolution and clinical pathologic correlations of de novo donor-specific HLA antibody post kidney transplant. Am J Transplant, 2012, 12(5): 1157-1167.
5. 石炳毅, 陳莉萍. 中國腎移植排斥反應臨床診療指南 (2016 版). 器官移植, 2016, (5): 332-338.
6. Amer YS, Elzalabany MM, Omar TI, et al. The 'Adapted ADAPTE': an approach to improve utilization of the ADAPTE guideline adaptation resource toolkit in the Alexandria Center for Evidence-Based Clinical Practice Guidelines. J Eval Clin Pract, 2015, 21(6): 1095-1106.
7. O'Donoghue KJM, Reed RD, Knight SR, et al. Systematic review of clinical practice guidelines in kidney transplantation. BJS Open, 2017, 1(4): 97-105.
8. Tong A, Chapman JR, Wong G, et al. Screening and follow-up of living kidney donors: a systematic review of clinical practice guidelines. Transplantation, 2011, 92(9): 962-972.
9. Alonso-Coello P, Irfan A, Solà I, et al. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care, 2010, 19(6): e58.
10. 曾力楠, 易秋莎, 張川, 等. 制訂指南臨床適用性評價工具. 中國循證醫學雜志, 2020, DOI: 10.7507/1672-2531.201904131.
11. Tabachnick BG, Fidell LS. Using multivariate statistics (5th edtion). New York: Allyn and Bacon, 2007.
12. 孫振球, 徐勇勇. 醫學統計學. 北京: 人民衛生出版社, 2014.
13. Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: The RIGHT Statement. Ann Intern Med, 2017, 166(2): 128-132.
14. 中華醫學會器官移植學分會. 腎移植排斥反應臨床診療技術規范 (2019 版). 器官移植, 2019, 10(5): 505-512.
15. 汪宏, 包旭. 臨床診療指南的獲取、評價與應用. 中國執業藥師, 2012, 9(4): 47-50.
16. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-E842.
17. O?Donoghue KJM, Reed RD, Knight SR, et al. Critical appraisal of international clinical practice guidelines in kidney transplantation using the appraisal of guidelines for research and education ii tool: a systematic review. Transplantation, 2018, 102(9): 1419-1439.
18. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant, 2009, 9(Suppl 3): S1-155.
19. 陳江華, 何強. 《KDIGO 臨床實踐指南: 腎移植受者的診治》免疫抑制部分對我們的啟示. 中華移植雜志 (電子版), 2010, (3): 178-181.
20. 王芳, 楊洋, 劉孟宇, 等. 基于指南熟悉和使用程度探索中醫診療指南實施推廣策略. 中華中醫藥雜志, 2016, 31(8): 3162-3165.

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An empirical study on evaluation of clinical applicability of kidney transplantation guideline

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