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      The development of clinical guidelines in China: insights from a national survey


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          Previous research suggests that the quality of clinical guidelines (CGs) in China is suboptimal. However, little is known about the methodology that CGs follow. We conducted a national survey of methods used by Chinese CG developers for CG development, adaptation, and updating.


          We used a previously piloted questionnaire based on methodologies of CG development, adaptation, and updating, which was distributed during September–November 2020 to 114 organizations identified from published Chinese CGs (searched 2017–2020), recommended by Chinese CG developers, and recommended by clinical discipline experts.


          We collected 48 completed questionnaires (42.1% response). Most organizations developed CGs based on scientific evidence (89.6%), existing CGs (75%), or expert experience and opinion (64.6%). Only a few organizations had a specific CG development division (6.3%), a CG monitoring plan (on clinicians 33.3%; on patients 18.8%), funding (33.3%), or a conflict-of-interest (COI) management policy (23.4%). Thirty (62.5%) organizations reported using a CG development methodology handbook, from international organizations (14/30, 46.7%), methodology or evaluation resources (3/30, 10.0%), expert experience and opinion (3/30, 10.0%), or in-house handbooks (3/30, 10.0%). One organization followed a published adaptation methodology. Thirty-eight organizations (88.4%) reported de novo CG development: 21 (55.3%) formed a CG working group, and 29 (76.3%) evaluated the quality of evidence (21 [72.4%] using a methodological tool). Nineteen organizations (52.8%) reported CG adaptation: three (31.6%) had an adaptation working group, and 12 (63.2%) evaluated the quality of source CGs (2 (16.7%) using the AGREE II instrument). Thirty-three organizations (68.8%) updated their CGs, seven (17.5%) using a formal updating process.


          Our study describes how CGs are developed in a middle-income country like China. To ensure better healthcare, there is still an important need for improvement in the development, adaptation, and updating of CG in China.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12961-021-00799-7.

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          Most cited references42

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          GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

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            AGREE II: advancing guideline development, reporting and evaluation in health care.

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              How to plan and perform a qualitative study using content analysis


                Author and article information

                Health Res Policy Syst
                Health Res Policy Syst
                Health Research Policy and Systems
                BioMed Central (London )
                23 December 2021
                23 December 2021
                : 19
                [1 ]GRID grid.412633.1, Department of Gynaecology, , First Affiliated Hospital of Zhengzhou University, ; Zhengzhou, China
                [2 ]GRID grid.413396.a, ISNI 0000 0004 1768 8905, Iberoamerican Cochrane Centre – Department of Clinical Epidemiology and Public Health, , Biomedical Research Institute Sant Pau (IIB Sant Pau), ; Barcelona, Spain
                [3 ]GRID grid.7080.f, ISNI 0000 0001 2296 0625, Vall d’Hebron University Hospital Research Institute (VHIR), , Universitat Autònoma de Barcelona, ; Barcelona, Spain
                [4 ]GRID grid.32566.34, ISNI 0000 0000 8571 0482, Evidence-Based Medicine Center, School of Basic Medical Sciences, , Lanzhou University, ; Lanzhou, China
                [5 ]GRID grid.32566.34, ISNI 0000 0000 8571 0482, WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, ; Lanzhou, China
                [6 ]GRID grid.466571.7, ISNI 0000 0004 1756 6246, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), ; Madrid, Spain
                [7 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Department of Health Research Methods, Evidence, and Impact (HEI), , McMaster University, ; Hamilton, Canada
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Funded by: Zhengzhou University Overseas Virtual Research Institute and the Chinese Scholarship Council
                Award ID: No 201707040103
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