Béland F
Département de santé communautaire, Cité de la santé de Laval, Montreal, Canada.
Med Care. 1988 Feb;26(2):115-23.
There are two conceptual problems with the study of the utilization of ambulatory care: 1) a problem of definition and 2) a problem of measurement. Large multivariate studies conceptualize utilization in a straightforward and static manner that is reflected in the way they measure utilization: as a sum of the number of visits to physicians over a period of time. However, utilization can be construed as a process occurring through time. The object of an analysis of utilization is to examine the causes of the changes in the levels of utilization patients undergo from one period to the next. In this paper, a Markovian model for studying utilization as a process is set up, using data on utilization from a sample of 2,149 patients from Montreal (1981). Results show that the effect of age and sex on utilization is not structured in the same way when using a Markovian model as when using a traditional model, where utilization is measured by the number of visits in one period. Thus, the results of large multivariate studies are most probably biased.
1）定义问题；2）测量问题。大型多变量研究以一种直接且静态的方式对利用情况进行概念化，这反映在它们测量利用情况的方式上：即一段时间内就诊次数的总和。然而，利用情况可被理解为一个随时间发生的过程。利用情况分析的目的是研究患者在不同时期利用水平变化的原因。本文利用来自蒙特利尔的2149名患者样本（1981年）的利用数据，建立了一个将利用情况作为过程进行研究的马尔可夫模型。结果表明，当使用马尔可夫模型时，年龄和性别对利用情况的影响与使用传统模型（在传统模型中利用情况通过某一时期的就诊次数来衡量）时的结构不同。因此，大型多变量研究的结果很可能存在偏差。
