外科医の成果の公的報告: 手術の数が少ないことが,偽りの自惚れにつながります
Kate Walker1, Jenny Neuburger, Oliver Groene
1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Lancet (London, England)
|July 9, 2013
まとめ
外科医の業績に関する公的な報告は,誤解を招く可能性があります. 低処置数は,偽りの自惚れを生み出し,それがそうでない場合でも許容可能なパフォーマンスを示唆します. 報告は,頻繁なアウトカムに焦点を当て,稀な処置の病院レベルのデータを考慮する必要があります.
科学分野:
- 医療サービス 研究 医療サービス
- 外科手術の結果分析
- 患者の安全性についてです.
背景:
- 英国の国立保健サービス (NHS) は,2013年に10の外科専門分野における個々の外科医のアウトカムデータを公表した.
- 結果データに基づいて外科医のパフォーマンスを評価するには,信頼できる統計分析のための十分な量の手順が必要です.
研究 の 目的:
- 個々の外科医が,公表されたアウトカムデータから,不十分なパフォーマンスを信頼性のある方法で特定するために,毎年十分な手順を実行しているかどうかを評価するために.
- 低処置量による死亡率の高い外科医の特定の正確性への影響を決定する.
主な方法:
- 英国のNHSの10つの専門分野における個々の外科医の手順量データの分析.
- 手術の容量と,不良な手術パフォーマンスを確実に検出する能力の関係に関する統計的評価.
主要な成果:
- いくつかの外科専門分野では,個々の外科医が実施する年間手術数は少ない.
- 低処置量は,死亡率が大幅に増加した外科医を確実に特定するための統計力を制限する.
- 小規模な専門分野における個々の外科医の成果を公に報告することは,偽りの安全感や自慢感をもたらす可能性があります.
結論:
- 個々の外科医の成果の公的報告には,処置量の慎重な検討が必要である.
- 推奨事項には,頻繁なアウトカムに焦点を当て,低需要の専門分野について病院レベルでの報告を使用し,不良パフォーマンスの証拠がないことを,許容可能なパフォーマンスの証拠として解釈することを避けるというものがあります.
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