识别潜在的低价值外科护理:英格兰的一项国家生态研究
Tim Jones1,2, Angus McNair3,4, Hugh McLeod5,6
1Research Fellow, The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Journal of health services research & policy
|May 9, 2024
概括
英国手术手术的变异分析发现了潜在的低价值护理. 这种方法可以帮助优化服务,通过标记昂贵的,无效的治疗方法来减少采用和指导研究优先事项.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 手术结果分析手术结果分析
- 卫生经济学 卫生经济学
背景情况:
- 临床实践的高差异可能表明不确定性和潜在的低价值护理.
- 目前用于识别低价值护理的现有方法往往不清楚,缺乏透明度,并且耗时.
研究的目的:
- 探索使用常规收集的英国手术程序数据的变异分析的实用性.
- 通过分析手术率和地理差异,识别潜在的低价值手术护理.
主要方法:
- 国家生态研究利用来自英格兰的医院情节统计 (HES) 数据 (2014/15-2018/19).
- 确定了具有高增长率和显著地理差异的外科手术程序 (差异的系统组件>1.6).
- 进行文献审查,以评估确定程序的成本效益和临床证据.
主要成果:
- 六种手术显示出高增长率 (≥37%在5年内);四种手术显示出显著的地理差异.
- 证据仅支持两项手术的成本效益;八项手术的临床和/或成本效益不明.
- 确定的潜在的低价值手术包括深度大脑刺激,前列腺切除,脊柱手术,创伤相关手术和关节置换.
结论:
- 变异分析是一种可行的方法,用于定期识别潜在的低价值手术程序.
- 这种方法为优化服务和取消无效,昂贵干预措施提供了洞察力.
- 早期识别有助于优先考虑临床试验,在治疗成为标准实践之前产生证据.
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