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医生对患者干预之外身体健康结局的影响：一项方法学综述

The Doctors' Effect on Patients' Physical Health Outcomes Beyond the Intervention: A Methodological Review.

作者信息

Schnelle Christoph, Jones Mark A

机构信息

Institute of Evidence-Based Healthcare, Bond University, Robina, QLD, 4226, Australia.

出版信息

Clin Epidemiol. 2022 Jul 18;14:851-870. doi: 10.2147/CLEP.S357927. eCollection 2022.

DOI:10.2147/CLEP.S357927
PMID:35879943
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9307914/
Abstract

BACKGROUND

Previous research suggests that when a treatment is delivered, patients' outcomes may vary systematically by medical practitioner.

OBJECTIVE

To conduct a methodological review of studies reporting on the effect of doctors on patients' physical health outcomes and to provide recommendations on how this effect could be measured and reported in a consistent and appropriate way.

METHODS

The data source was 79 included studies and randomized controlled trials from a systematic review of doctors' effects on patients' physical health. We qualitatively assessed the studies and summarized how the doctors' effect was measured and reported.

RESULTS

The doctors' effects on patients' physical health outcomes were reported as fixed effects, identifying high and low outliers, or random effects, which estimate the variation in patient health outcomes due to the doctor after accounting for all available variables via the intra-class correlation coefficient. Multivariable multilevel regression is commonly used to adjust for patient risk, doctor experience and other demographics, and also to account for the clustering effect of hospitals in estimating both fixed and random effects.

CONCLUSION

This methodological review identified inconsistencies in how the doctor's effect on patients' physical health outcomes is measured and reported. For grading doctors from worst to best performances and estimating random effects, specific recommendations are given along with the specific data points to report.

摘要

背景

先前的研究表明，在进行治疗时，患者的治疗结果可能会因医生的不同而存在系统性差异。

目的

对报告医生对患者身体健康结果影响的研究进行方法学综述，并就如何以一致且恰当的方式衡量和报告这种影响提供建议。

方法

数据来源为对医生对患者身体健康影响的系统评价中的79项纳入研究和随机对照试验。我们对这些研究进行了定性评估，并总结了医生影响的衡量和报告方式。

结果

医生对患者身体健康结果的影响被报告为固定效应（识别高、低异常值）或随机效应（通过组内相关系数在考虑所有可用变量后估计因医生导致的患者健康结果差异）。多变量多层次回归通常用于调整患者风险、医生经验和其他人口统计学因素，同时在估计固定效应和随机效应时考虑医院的聚类效应。

结论

本方法学综述发现，在医生对患者身体健康结果影响的衡量和报告方式上存在不一致之处。对于从最差到最佳表现对医生进行分级以及估计随机效应，给出了具体建议以及需要报告的具体数据点。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cec1/9307914/0d1549d63673/CLEP-14-851-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cec1/9307914/9dbb84578f70/CLEP-14-851-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cec1/9307914/398ebcfe493e/CLEP-14-851-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cec1/9307914/c3beba1ef012/CLEP-14-851-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cec1/9307914/a5d070f383de/CLEP-14-851-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cec1/9307914/0d1549d63673/CLEP-14-851-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cec1/9307914/9dbb84578f70/CLEP-14-851-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cec1/9307914/398ebcfe493e/CLEP-14-851-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cec1/9307914/c3beba1ef012/CLEP-14-851-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cec1/9307914/a5d070f383de/CLEP-14-851-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cec1/9307914/0d1549d63673/CLEP-14-851-g0005.jpg

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