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变化测量中的变化:对研究临床变化的方法进行映射审查
Amity E Quinn1,2,3, Jason E Black1,3, Derek Chew1,4,5
1Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Journal of evaluation in clinical practice
|January 22, 2026
概括
了解临床变异是提高医疗保健价值的关键. 这次审查发现,当前的方法经常识别变化,但难以量化或解释其来源,突出需要更好的测量方法.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 临床流行病学临床流行病学
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 医疗保健提供在提供者,实践和系统之间表现出差异.
- 了解临床变异对于识别过度使用低价值护理和不足使用高价值护理至关重要.
- 现有的描述和量化临床变异的方法被不一致地应用.
研究的目的:
- 系统地识别和描述用于描述和量化医疗保健中的临床变异的方法.
- 绘制用于临床变异研究的方法的地图.
- 为改善衡量医疗保健变异的方法提供信息.
主要方法:
- 一个映射审查系统地搜索了医疗保健和医疗服务文献,以研究临床变异.
- 用关键词分析来识别图形和统计方法,专业,设置和性能领域.
- 包括的研究测量了个人或更高层次的护理过程或健康结果,使用例行收集的数据.
主要成果:
- 分析了6000多项研究,其中大多数采用了回归或粗略比较等基本方法.
- 不到1000项研究使用了先进的多层模型来量化变化.
- 多级模型很少用于研究医疗保健质量变化.
结论:
- 目前研究临床变异的方法主要是确定其存在,而不是量化或解释其潜在原因.
- 本综述提供了关于测量变化的现有方法的范围和应用的见解.
- 改善临床变异的测量对于提高医疗保健价值和公平性至关重要.
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