体外受精诊所排行榜的可靠性：活产率的回顾性分析
Reliability of league tables of in vitro fertilisation clinics: retrospective analysis of live birth rates.
作者信息
Marshall E C, Spiegelhalter D J
机构信息
MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2 2SR.
出版信息
BMJ. 1998 Jun 6;316(7146):1701-4; discussion 1705. doi: 10.1136/bmj.316.7146.1701.
OBJECTIVE
To determine to what extent institutions carrying out in vitro fertilisation can reasonably be ranked according to their live birth rates.
DESIGN
Retrospective analysis of prospectively collected data on live birth rate after in vitro fertilisation.
SETTING
52 clinics in the United Kingdom carrying out in vitro fertilisation over the period April 1994 to March 1995.
MAIN OUTCOME MEASURE
Estimated adjusted live birth rate for each clinic; their rank and its associated uncertainty.
RESULTS
There were substantial and significant differences between the live birth rates of the clinics. There was great uncertainty, however, concerning the true ranks, particularly for the smaller clinics. Only one clinic could be confidently ranked in the bottom quarter according to this measure of performance. Many centres had substantial changes in rank between years, even though their live birth rate did not change significantly.
CONCLUSIONS
Even when there are substantial differences between institutions, ranks are extremely unreliable statistical summaries of performance and change in performance, particularly for smaller institutions. Any performance indicator should always be associated with a measure of sampling variability.
目的
确定开展体外受精的机构在多大程度上能够根据其活产率进行合理排名。
设计
对前瞻性收集的体外受精后活产率数据进行回顾性分析。
研究地点
1994年4月至1995年3月期间在英国开展体外受精的52家诊所。
主要观察指标
各诊所的估计调整后活产率；其排名及其相关不确定性。
结果
各诊所的活产率存在显著差异。然而，关于真实排名存在很大的不确定性，尤其是对于规模较小的诊所。根据这一绩效衡量标准，只有一家诊所能够被确定排在最后四分之一。许多中心在不同年份之间排名有很大变化，尽管其活产率没有显著变化。
结论
即使机构之间存在显著差异，排名也是极不可靠的绩效统计总结以及绩效变化总结，尤其是对于规模较小的机构。任何绩效指标都应始终与抽样变异性的衡量指标相关联。
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