在实践中的案例混合调整的情况. 当好的果看起来不好的时候
相关实验视频
S Salem-Schatz1, G Moore, M Rucker
1Harvard Community Health Plan, Brookline, MA 02146.
JAMA
|September 21, 1994
概括
根据患者特征进行调整可以显著减少实践变化,并识别出更少的异常医生. 如果不考虑患者病例组合,可能会导致不准确的医生绩效评估和错误的质量改善努力.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
- 医生绩效测量方法 医生绩效测量方法
背景情况:
- 医生实践分析对质量评估至关重要.
- 患者的特征可以影响观察到的实践模式.
- 准确的实践分析需要考虑患者病例组合.
研究的目的:
- 评估患者特征对医生实践概况的影响.
- 评估年龄/性别与病例组合的调整如何影响实践变异估计.
- 确定对识别异常医生和变异预测者的影响.
主要方法:
- 在52个医生实践中对37,830名患者进行了回顾性队列研究.
- 计算未调整的推率和调整的标准化推率.
- 使用变化系数分析变化和异常值状态的确定.
主要成果:
- 根据患者特征进行调整,使变化率降低了50%以上.
- 75%的年龄/性别调整的异常值在考虑病例组合时没有被确定.
- 未调整的转诊率的预测因素 (例如,医生年龄,执业时间) 在调整后失去意义.
结论:
- 如果未能根据案例组合进行调整,则会高估实践变化,并错误地识别异常值.
- 不准确的个人资料可能导致不公平的医生决策 (教育,制裁,就业).
- 关于实践变化的错误信息可能会误导质量改进资源.
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