Šinkovec Hana, Gall Walter, Heinze Georg
Institute of Clinical Biometrics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria.
Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia.
Med Care. 2024 Nov 1;62(11):748-756. doi: 10.1097/MLR.0000000000002057. Epub 2024 Oct 11.
Practice guidelines recommend patient management based on scientific evidence. Quality indicators gauge adherence to such recommendations and assess health care quality. They are usually defined as adverse event rates, which may not fully capture guideline adherence over time.
For assessing process indicators where compliance to the recommended treatment can be assessed by evaluating a patient's trace in linked routine databases, we propose using restricted mean survival time or restricted mean time lost, which are applicable even in competing risk situations. We demonstrate their application by assessing the compliance of patients with acute myocardial infarction (AMI) to high-power statins over 12 months in Austria's political districts, using pseudo-observations and employing causal inference methods to achieve regional comparability.
We analyzed the compliance of 31,678 AMI patients from Austria's 116 political districts with index AMI between 2011 and 2015. The results revealed considerable compliance variations across districts but also plausible spatial similarities.
Restricted mean survival time and restricted mean time lost provide interpretable estimates of patients' expected time in compliance (lost), well-suited for risk-adjusted entity comparisons in the presence of (measurable) confounding, censoring, and competing risks.
实践指南建议依据科学证据进行患者管理。质量指标衡量对这些建议的遵循情况并评估医疗质量。它们通常被定义为不良事件发生率，而这可能无法全面反映长期的指南遵循情况。
为了评估过程指标，在通过评估患者在关联的常规数据库中的轨迹来评估对推荐治疗的依从性时，我们建议使用受限平均生存时间或受限平均失访时间，即使在存在竞争风险的情况下它们也适用。我们通过评估奥地利各行政区急性心肌梗死（AMI）患者在12个月内对高强度他汀类药物的依从性来展示它们的应用，使用虚拟观察值并采用因果推断方法以实现区域可比性。
我们分析了2011年至2015年间奥地利116个行政区中31,678例首次发生AMI的患者的依从性。结果显示各行政区之间存在显著的依从性差异，但也有合理的空间相似性。
受限平均生存时间和受限平均失访时间为患者的预期依从时间（失访时间）提供了可解释的估计值，非常适合在存在（可测量的）混杂、删失和竞争风险的情况下进行风险调整后的实体比较。
