Rice N, Leyland A
Centre for Health Economics, University of York, UK.
J Health Serv Res Policy. 1996 Jul;1(3):154-64. doi: 10.1177/135581969600100307.
This paper presents an introductory account of multilevel models, highlighting the potential benefits that may be gained by the use of these methods. It draws on recent applications in health services research that have appeared in the literature. Methodological advances in these statistical techniques have taken place in the field of education, where empirical studies have mainly been concerned with comparing pupil achievement across different schools by exploring the relationship between individual and institutional factors. Although recent widespread availability of suitable software packages has enabled other disciplines to adopt these methods, to date they have received little attention in the health services research literature (the investigation of effects of geographical areas on health being a possible exception) despite their obvious application in many areas of current interest. Key areas that could benefit greatly from these techniques include the exploration of variations in clinical practice, comparisons of institutional performance and resource allocation.
本文介绍了多层模型，重点强调了使用这些方法可能带来的潜在益处。它借鉴了文献中近期在卫生服务研究中的应用。这些统计技术的方法学进展发生在教育领域，在该领域实证研究主要关注通过探索个体因素与机构因素之间的关系来比较不同学校学生的成绩。尽管近期合适软件包的广泛可得使其他学科能够采用这些方法，但迄今为止，它们在卫生服务研究文献中很少受到关注（地理区域对健康影响的调查可能是个例外），尽管它们在当前许多感兴趣的领域有明显应用。能从这些技术中极大受益的关键领域包括临床实践差异的探索、机构绩效比较和资源分配。
