Jones K, Moon G
Department of Geography, Portsmouth Polytechnic, Hampshire.
BMJ. 1991 Jul 6;303(6793):28-31. doi: 10.1136/bmj.303.6793.28.
To provide a measure of general practitioners' performance regarding uptake of immunisation against pertussis, taking account of the impact of patient characteristics on levels of uptake.
Multilevel model of immunisation status against six measures of patient characteristics (level 1 predictor variables) with practice constraints as level 2 variables.
126 practices in southern England.
2048 infants identified from infant surveillance and immunisation records.
Top 10 practices with respect to uptake of pertussis immunisation according to a "null" model (model A) and according to a model that included six level 1 variables (model B); differences in ranking between the two models.
Practices with low numbers of infants' requiring immunisation had imprecise and unstable uptake rates (range 0%-100%). With the multilevel procedure, after controlling for patient characteristics, practices in suburban catchment areas comprised largely of mature or young professionals performed best. Most improved performances when patient characteristics were taken into account were in practices in areas with a stable population and local authority housing--one such practice improved its ranking by 47 places.
Crude uptake rates are inadequate performance indicators. Alternative approaches suggest that praiseworthy efforts to raise immunisation rates in unpromising areas are unrewarded by simple target based assessments.
考虑患者特征对疫苗接种率的影响，衡量全科医生在百日咳疫苗接种方面的表现。
针对六种患者特征测量指标（一级预测变量）建立免疫状态的多层次模型，将实践限制作为二级变量。
英格兰南部的126个医疗机构。
从婴儿监测和免疫记录中识别出的2048名婴儿。
根据“空”模型（模型A）和包含六个一级变量的模型（模型B），百日咳疫苗接种率排名前十的医疗机构；两个模型排名的差异。
需要接种疫苗的婴儿数量较少的医疗机构，其接种率不准确且不稳定（范围为0%-100%）。采用多层次程序，在控制患者特征后，主要由成熟或年轻专业人员组成的郊区集水区的医疗机构表现最佳。考虑患者特征后，大多数表现改善的是人口稳定和有地方政府住房地区的医疗机构——其中一家医疗机构的排名提高了47位。
粗略的接种率是不充分的绩效指标。其他方法表明，在前景不佳地区提高免疫接种率的值得称赞的努力，在基于简单目标的评估中得不到回报。
