関連する実験動画
病院での"リスク調整"結果の比較
David M Shahian1, Sharon-Lise T Normand
1Center for Quality and Safety, Department of Surgery, and Institute for Health Policy, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02115, USA.
Circulation
|April 9, 2008
まとめ
病院でのアウトカムを比較するには,慎重にリスク調整する必要があります. 機関間の直接的な比較は,ケースミックス分布が著しく重なり,適切な統計的方法の必要性を強調しない限り,しばしば誤解を招く.
科学分野:
- 医療サービス 研究 医療サービス
- アウトカム 研究成果 研究成果
- 医療政策分析 医療政策分析
背景:
- 異なる集団における医療成果を比較することは大きな課題です.
- 病院のパフォーマンス指標,特にリスク調整されたアウトカムについては,しばしば誤解されています.
- リスク調整のみに基づいた機関を直接比較することは,誤解を招く可能性があります.
研究 の 目的:
- リスク調整を使用して,病院でのアウトカム間の直接比較の妥当性を評価する.
- リスク調整された死亡率の解釈に対するケースミックス比較性の影響を評価する.
- リスク調整された結果が,機関間比較のために信頼できる使用が可能な時期を判断する.
主な方法:
- マサチューセッツ州の14の病院で隔離された冠動脈バイパス移植手術後の30日間の全原因死亡率の分析 (2003年).
- 病院の死亡率の間接的な標準化のために,階層的なロジスティック回帰を使用しました.
- 病院間のケースミックス比較性とコバリアートバランスを評価するための従業員の傾向スコア.
主要な成果:
- ケースミックスにおける十分な重複は,個々の病院のパフォーマンスを全体と比較して一般的に正当化されます.
- 病院の対照的な比較は,ケース・ミックスにおける有意な差異を明らかにし,直接的な比較性に疑問を投げかけました.
- リスク調整だけでは,プロバイダの直接のサイド・バイ・サイド分析の比較性を保証することはできません.
結論:
- リスク調整された結果は,平均的なプロバイダーと比較して特定のケースミックスに対するプロバイダのパフォーマンスを反映しています.
- リスク調整されたアウトカムを使用する機関を直接比較することは,ケースミックス分布の重複が実証されない限り,不適切です.
- 傾向スコアは,共変数のバランスを改善し,適切な場合,比較分析を正当化するのに役立ちます.
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