Feussner J R
Health Services Research and Development Field Program (Center in Primary Care), Durham Veterans Affairs Medical Center, NC 27705.
J Am Geriatr Soc. 1991 Sep;39(9 Pt 2):19S-24S. doi: 10.1111/j.1532-5415.1991.tb05929.x.
A multi-site randomized controlled trial could most conclusively establish the efficacy of geriatric evaluation and management units, but many questions must be answered to design such a trial. First, the research questions needs to be rigorously specified. This will facilitate decisions concerning the types of patients to be included in the study. Second, the intervention requires a clear definition, including its component parts, to improve replication across multiple sites. Third, the type of randomization (ie, by hospital or by patient) and the timing of randomization (ie, at admission or at some later point during care) need to be considered. Fourth, because this type of intervention cannot be administered in a blind fashion, bias is a critical concern. Outcome measures must be selected carefully so that those least susceptible to bias are given the highest priority. Despite the need to address all of these questions, the time is upon us to conduct a multi-site trial of geriatric evaluation and management programs.
一项多中心随机对照试验能够最确凿地证实老年评估与管理单元的疗效，但要设计这样一项试验，必须回答许多问题。首先，研究问题需要严格明确。这将有助于做出有关纳入研究的患者类型的决策。其次，干预措施需要明确定义，包括其组成部分，以提高在多个中心的可重复性。第三，需要考虑随机化的类型（即按医院或按患者）以及随机化的时间（即在入院时或在护理过程中的某个稍后时间点）。第四，由于这类干预措施无法以盲法实施，偏倚是一个关键问题。必须仔细选择结局指标，以便将最不易受偏倚影响的指标列为最优先考虑对象。尽管需要解决所有这些问题，但开展老年评估与管理项目多中心试验的时机已经到来。
