Hicks N R
Department of Public Health and Health Policy, Oxfordshire Health Authority, Headington.
BMJ. 1994 Sep 17;309(6956):730-3. doi: 10.1136/bmj.309.6956.730.
There are a growing number of published studies that suggest that much health care is delivered inappropriately. There are calls for measures of appropriateness to be used by purchasers and others to regulate or influence the delivery of health care. This paper explores assumptions inherent in results generated by a leading measure of appropriateness and concludes that there are considerable uncertainties about the measure's meaning, the magnitude of bias that it contains, and the degree to which its application can be generalised. Some of these uncertainties could be resolved if the tacit assumptions inherent in the generation of the criteria could be made explicit. Existing measures of appropriateness are not yet sufficiently robust to be used with confidence to influence or control the delivery of health care. They may have a use as an aid rather than as a constraint in clinical decision making. A randomised controlled trial could resolve whether patients achieve better outcomes if their care is influenced by appropriateness criteria.
越来越多已发表的研究表明，许多医疗服务的提供并不恰当。购买方及其他各方呼吁采用适宜性衡量标准来规范或影响医疗服务的提供。本文探讨了一种主要适宜性衡量标准所产生结果中固有的假设，并得出结论：该衡量标准的含义、所含偏差的程度以及其应用可推广的程度存在相当大的不确定性。如果能够明确生成这些标准时所隐含的假设，其中一些不确定性是可以解决的。现有的适宜性衡量标准还不够稳健，无法放心地用于影响或控制医疗服务的提供。它们在临床决策中可能更适合作为一种辅助手段，而非限制因素。一项随机对照试验可以确定，如果根据适宜性标准来影响患者的治疗，患者是否能获得更好的治疗效果。
