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医学研究中的风险调整:鸟瞰图。

Risk Adjustment in Medical Research: A Bird's Eye View.

机构信息

Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Independent Research Consultant, Shiraz, Iran.

出版信息

J Korean Med Sci. 2024 Nov 18;39(44):e324. doi: 10.3346/jkms.2024.39.e324.

Abstract

Making correct decisions is of paramount importance in clinical medicine and health-related disciplines. Randomized clinical trials are considered the gold-standard type of study for the assessment of the efficacy of a treatment. However, conducting a randomized clinical trial is not always possible; observational studies should be conducted, instead. For lack of randomization in observational studies, there may be differences in the distributions of certain variables (, age, race, and quality of health care services) between the study groups that may result in a biased estimate of the outcome of interest. Risk adjustment methods are used to account for these differences and find an unbiased measure of the treatment effect. The method involves several steps including defining the outcome of interest and identifying its potential outcome predictors. Then, we need to operationalize the selected risk factors and construct a statistical model or other methods of adjustment. This will result in a more accurate (less biased) estimate of the treatment effect.

摘要

在临床医学和健康相关学科中,做出正确的决策至关重要。随机临床试验被认为是评估治疗效果的金标准研究类型。然而,并非总是可以进行随机临床试验;应进行观察性研究。由于观察性研究中缺乏随机分组,研究组之间某些变量(如年龄、种族和医疗保健服务质量)的分布可能存在差异,这可能导致对感兴趣结局的估计存在偏差。风险调整方法用于考虑这些差异,并找到治疗效果的无偏估计量。该方法包括几个步骤,包括定义感兴趣的结局及其潜在结局预测因素。然后,我们需要对选定的风险因素进行操作化,并构建统计模型或其他调整方法。这将导致对治疗效果的更准确(偏差较小)估计。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d954/11576222/b22a61a59843/jkms-39-e324-g001.jpg

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