推进研究医疗保健临床变异的方法
Jason E Black1,2, Derek S Chew1,3, Tyler S Williamson1,2,4
1Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
了解临床变异或医疗实践中的差异是改善患者护理的关键. 本综述指导研究人员描述和量化这种变化的方法,以识别和解决效率低下的问题.
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
- 生物统计学 生物统计学
背景情况:
- 临床变异,也称为医疗实践变异,是指患者护理和各种维度的结果之间的差异.
- 了解无法解释的临床变异对于识别医疗保健中的过度使用,不足使用,低效率和不平等至关重要.
- 现有的文献缺乏用于研究临床变异的方法的全面描述.
研究的目的:
- 为研究人员提供关于描述和量化临床变异的非技术方法指南.
- 描述和比较分析临床变异的各种方法.
- 作为检查卫生服务研究中的临床变异的资源.
主要方法:
- 可视化:点和图,散射图,毛虫图,盒子图和漏斗图都用于显示临床变异.
- 统计方法:讨论了基本的测量方法,如差异,标准偏差,变化系数和四分位数间范围.
- 多级模型:描述了先进的方法来测量变化大小,识别贡献水平,并使用统计数据,如类内相关系数和赔率比率等统计数据来探索解释因素.
主要成果:
- 道图表可以在调整案例混合后识别超过预期水平的变化.
- 多层次模型量化变化,并确定不同层次 (患者,提供者,医院) 解释变化的因素.
- 关键考虑因素包括适当测量护理/结果,识别合理与不合理的变化,以及潜在的干预措施.
结论:
- 本综述概述了描述和量化临床变异的技术.
- 它旨在为研究人员提供有效分析和理解医疗实践差异的知识.
- 该指南支持通过解决不合理的临床变异来改善医疗保健质量的努力.
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