Hospital Universitario Miguel Servet, Zaragoza, Spain.
Hospital del Mar, Barcelona, Spain.
BMC Health Serv Res. 2020 Apr 14;20(1):297. doi: 10.1186/s12913-020-05085-w.
Evaluation of renal replacement therapy with haemodialysis is essential for its improvement. Remarkably, outcomes vary across centres. In addition, the methods used have important epistemological limitations, such as ignoring significant features (e.g., quality of life) or no relevance given to the patient's perspective in the indicator's selection. The present study aimed to determine the opinions and preferences of stakeholders (patients, clinicians, and managers) and establish their relative importance, considering the complexity of their interactions, to facilitate a comprehensive evaluation of haemodialysis centres.
Successive working groups (WGs) were established using a multicriteria methodology. WG1 created a draft of criteria and sub-criteria, WG2 agreed, using a qualitative structured analysis with pre-established criteria, and WG3 was composed of three face-to-face subgroups (WG3-A, WG3-B, and WG3-C) that weighted them using two methodologies: weighted sum (WS) and analytic hierarchy process (AHP). Subsequently, they determined a preference for the WS or AHP results. Finally, via the Internet, WG4 weighted the criteria and sub-criteria by the method preferred by WG3, and WG5 analysed the results.
WG1 and WG2 identified and agreed on the following evaluation criteria: evidence-based variables (EBVs), annual morbidity, annual mortality, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMs). The EBVs consisted of five sub-criteria: type of vascular access, dialysis dose, haemoglobin concentration, ratio of catheter bacteraemia, and bone mineral disease. The patients rated the PROMs with greater weight than the other stakeholders in both face-to-face WG3 (WS and AHP) and WG4 via the Internet. The type of vascular access was the most valued sub-criterion. A performance matrix of each criterion and sub-criterion is presented as a reference for assessing the results based on the preferences of the stakeholders.
The use of a multicriteria methodology allows the relative importance of the indicators to be determined, reflecting the values of the different stakeholders. In a performance matrix, the inclusion of values and intangible aspects in the evaluation could help in making clinical and organizational decisions.
评估血液透析的肾脏替代疗法对于改善该疗法至关重要。值得注意的是，不同中心的结果存在差异。此外，所使用的方法具有重要的认识论局限性，例如忽略重要特征（例如，生活质量）或在指标选择中不考虑患者的观点。本研究旨在确定利益相关者（患者、临床医生和管理人员）的意见和偏好，并确定其相对重要性，同时考虑到他们相互作用的复杂性，以促进对血液透析中心的全面评估。
使用多准则方法建立了连续的工作组（WG）。WG1 制定了标准和子标准草案，WG2 使用具有预先设定标准的定性结构分析达成一致意见，WG3 由三个面对面的小组（WG3-A、WG3-B 和 WG3-C）组成，使用两种方法对其进行加权：加权总和（WS）和层次分析法（AHP）。然后，他们确定了对 WS 或 AHP 结果的偏好。最后，WG4 通过互联网使用 WG3 偏好的方法对标准和子标准进行加权，WG5 对结果进行分析。
WG1 和 WG2 确定并同意了以下评估标准：基于证据的变量（EBVs）、年发病率、年死亡率、患者报告的结果测量（PROMs）和患者报告的体验测量（PREMs）。EBVs 由五个子标准组成：血管通路类型、透析剂量、血红蛋白浓度、导管菌血症的比例和骨矿物质疾病。患者在面对面的 WG3（WS 和 AHP）和通过互联网的 WG4 中对 PROMs 的评价权重都大于其他利益相关者。血管通路类型是最受重视的子标准。为每个标准和子标准呈现了一个绩效矩阵，作为根据利益相关者的偏好评估结果的参考。
使用多准则方法可以确定指标的相对重要性，反映不同利益相关者的价值观。在绩效矩阵中，评估中包含价值观和无形方面可以帮助做出临床和组织决策。
