Obas Katrina, Storari Chiara, Giuliani Francesca
Universitätsspital Zürich, Qualitätsmanagement & Patientensicherheit, Rämistrasse 100, Zürich, 8091, Switzerland.
Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland.
J Patient Rep Outcomes. 2025 Jul 15;9(1):90. doi: 10.1186/s41687-025-00922-0.
The rapid review aimed to analyse current practices and recommendations regarding case-mix adjustment for benchmarking Patient Reported Experience Measures (PREMs) across inpatient health centres. Findings will inform the applicability of case-mix adjustment to PREMs in the Swiss context.
We searched PubMed, Embase, and Web of Science for studies which met the following criteria: PREMs is a main outcome, study from a European country with a national inpatient PREMs survey, study with adult patients in acute care setting, and evaluates the effect of case-mix adjustment on PREMs. Screening and appraisal were performed by an experienced epidemiologist. A narrative evidence synthesis was undertaken to address the review question, with support of tables to summarize evidence on case-mix variables and statistical methods.
Seven studies (n = 301,833) were included. All supported case-mix adjustment to some extent, though variables used for case mix varied, complicating standardization. Concerns included the risk of masking quality differences. To address this, several authors advocated reporting both adjusted and unadjusted scores. Only one study included language spoken as a case mix variable-a key factor in Switzerland.
Case-mix adjustment can enhance fairness in PREM-based benchmarking but must be applied cautiously. For multilingual contexts like Switzerland, local relevance of adjustment variables should be evaluated. A stepwise, transparent approach is recommended to avoid obscuring true performance differences.
本快速综述旨在分析当前关于住院医疗中心患者报告体验指标（PREMs）基准化的病例组合调整的实践和建议。研究结果将为病例组合调整在瑞士背景下对PREMs的适用性提供参考。
我们在PubMed、Embase和科学网中检索符合以下标准的研究：PREMs为主要结局；来自有全国住院患者PREMs调查的欧洲国家的研究；针对急性护理环境中的成年患者的研究；评估病例组合调整对PREMs的影响。由一位经验丰富的流行病学家进行筛选和评估。在表格的支持下，进行叙述性证据综合以回答综述问题，总结关于病例组合变量和统计方法的证据。
纳入了七项研究（n = 301,833）。所有研究在一定程度上都支持病例组合调整，不过用于病例组合的变量各不相同，这使得标准化变得复杂。存在的问题包括掩盖质量差异的风险。为解决这一问题，几位作者主张同时报告调整后和未调整的分数。只有一项研究将所讲语言作为病例组合变量纳入——这在瑞士是一个关键因素。
病例组合调整可以提高基于PREM的基准化的公平性，但必须谨慎应用。对于像瑞士这样的多语言环境，应评估调整变量与当地的相关性。建议采用逐步、透明的方法，以避免掩盖真实的绩效差异。
