测试风险导向护理有效性的研究设计面临许多挑战:一个范围审查,解决关键考虑因素
Ana C Alba1, Andrea J Darzi2, Tayler A Buchan1
1Ted Rogers Center for Heart Research, Peter Munk Cardiac Center, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Journal of clinical epidemiology
|October 18, 2023
概括
为了评估风险导向护理,随机对照试验 (RCT) 提供了最可靠的证据. 观察性研究有局限性,有效的结论需要解决已识别的设计挑战.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 临床试验设计 临床试验设计
背景情况:
- 以患者出现不良结果的风险为指导的护理策略 (风险指导护理) 通过使用多种不同的研究设计进行评估.
- 优化这些研究结果的可靠性对于临床决策至关重要.
研究的目的:
- 审查评估风险指导护理的研究特征.
- 确定提高这一领域发现可靠性的关键设计特征.
主要方法:
- 进行了范围审查,搜索了五个数据库,寻找成人风险导向护理研究.
- 数据抽象和描述性总结专注于研究设计和特征.
- 从14561个初始记录中确定了116项符合条件的研究.
主要成果:
- 包括的研究设计包括随机对照试验 (RCT),后期RCT分析和队列研究.
- 确定的挑战和偏见包括:有限的预测模型性能,污染,不足的子组分析,缺乏根据风险区分护理,专注于过程措施,以及对益处/危害的不完整报告.
结论:
- 随机对照试验 (RCT) 是评估风险导向护理有效性的黄金标准.
- 可以使用观察性研究,但容易引起混和其他设计限制.
- 解决已识别的设计挑战对于得出关于风险导向护理的有效结论至关重要.
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