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患者出院访视抽样:使用数学推导和计算机模拟评估方法。

Sampling for Patient Exit Interviews: Assessment of Methods Using Mathematical Derivation and Computer Simulations.

机构信息

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.

Institute of Public Health, Heidelberg University, Heidelberg, Germany.

出版信息

Health Serv Res. 2018 Feb;53(1):256-272. doi: 10.1111/1475-6773.12611. Epub 2016 Nov 24.

Abstract

OBJECTIVE

(1) To evaluate the operational efficiency of various sampling methods for patient exit interviews; (2) to discuss under what circumstances each method yields an unbiased sample; and (3) to propose a new, operationally efficient, and unbiased sampling method.

STUDY DESIGN

Literature review, mathematical derivation, and Monte Carlo simulations.

PRINCIPAL FINDINGS

Our simulations show that in patient exit interviews it is most operationally efficient if the interviewer, after completing an interview, selects the next patient exiting the clinical consultation. We demonstrate mathematically that this method yields a biased sample: patients who spend a longer time with the clinician are overrepresented. This bias can be removed by selecting the next patient who enters, rather than exits, the consultation room. We show that this sampling method is operationally more efficient than alternative methods (systematic and simple random sampling) in most primary health care settings.

CONCLUSION

Under the assumption that the order in which patients enter the consultation room is unrelated to the length of time spent with the clinician and the interviewer, selecting the next patient entering the consultation room tends to be the operationally most efficient unbiased sampling method for patient exit interviews.

摘要

目的

(1)评估各种患者出院面谈抽样方法的运作效率;(2)讨论每种方法在何种情况下产生无偏样本;(3)提出一种新的、运作高效且无偏的抽样方法。

研究设计

文献回顾、数学推导和蒙特卡罗模拟。

主要发现

我们的模拟结果表明,在患者出院面谈中,如果面谈者在完成一次面谈后选择下一位即将离开临床咨询的患者,那么这种方法在操作上最为高效。我们从数学上证明,这种方法会产生有偏差的样本:与医生就诊时间较长的患者比例过高。通过选择下一位进入咨询室的患者而不是离开咨询室的患者,可以消除这种偏差。我们表明,在大多数初级保健环境中,这种抽样方法比替代方法(系统抽样和简单随机抽样)在操作上更有效率。

结论

在假设患者进入咨询室的顺序与与医生就诊时间长短无关的前提下,选择下一位进入咨询室的患者往往是患者出院面谈中运作效率最高的无偏抽样方法。

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