Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St. Box 63, Boston, MA, 02111, USA.
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Obes Surg. 2018 May;28(5):1321-1328. doi: 10.1007/s11695-017-2990-1.
The purpose of this study was to assess whether publication of clinical evidence was associated with increased utilization of bariatric surgery.
We systematically searched the literature (1994 to 2008) to identify studies on bariatric surgery. We sorted the evidence by publication date and citation frequency. We linked the published evidence to data from the Kaiser Permanente Washington (KPWA) on 1421 bariatric surgery cases and 45,665 medically managed patients with severe obesity to assess the association between evidence and use of bariatric surgery. We used an interrupted time series analysis with a control group to estimate the association. In secondary analyses, we examined the association with accumulating major clinical evidence, the type of evidence, and stratification by influential tiers.
A total of 9913 papers were identified and the top 100 cited papers were initially selected. After inclusion criteria were applied, 35 papers were selected. We selected the fourth quarter in 2004 as the exposure based on publication for the two studies with the largest number of citations. Compared to the projected secular trend, the publication of those two major articles was associated with 50 additional cases of bariatric surgery performed per 100,000 eligible individuals per quarter. In our secondary analyses, higher quality evidence (e.g., RCTs) and more highly cited evidence were each associated with a greater probability of receiving bariatric surgery.
For patient members of the KPWA with severe obesity, publication of clinical evidence was associated with increased use of bariatric surgery. This finding suggests that publication of higher quality positive clinical evidence may influence utilization.
本研究旨在评估临床证据的发表是否与减重手术利用率的增加相关。
我们系统地检索了文献（1994 年至 2008 年），以确定关于减重手术的研究。我们根据发表日期和引用频率对证据进行分类。我们将发表的证据与 Kaiser Permanente Washington（KPWA）的 1421 例减重手术病例和 45665 例患有严重肥胖的接受医学管理的患者数据联系起来，以评估证据与减重手术使用之间的关联。我们使用具有对照组的中断时间序列分析来估计关联。在二次分析中，我们检查了与累积主要临床证据、证据类型以及按有影响力的层次进行分层的关联。
共确定了 9913 篇论文，最初选择了前 100 篇被引用最多的论文。在应用纳入标准后，选择了 35 篇论文。我们根据引用次数最多的两项研究的发表情况，将 2004 年第四季度作为暴露因素。与预期的季节性趋势相比，这两项主要研究的发表与每季度每 10 万合格人群中额外进行 50 例减重手术相关。在我们的二次分析中，更高质量的证据（例如 RCT）和被引用次数更多的证据与接受减重手术的可能性更大相关。
对于 KPWA 中患有严重肥胖的患者成员，临床证据的发表与减重手术利用率的增加相关。这一发现表明，更高质量的阳性临床证据的发表可能会影响利用率。
