Provider- and Facility-Level Variation in Precancerous Cervical Biopsy Diagnoses.
Provider- and Facility-Level Variation in Precancerous Cervical Biopsy Diagnoses.
复制标题
癌前宫颈活检诊断中的提供者和设施水平差异。
DOI：
10.1097/lgt.0000000000000721
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发表时间：
2023
影响因子：
3.7
通讯作者：
Silverberg,M
中科院分区：
文献类型：
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作者：
DelVecchio,NatalieJ;Beaber,ElisabethF;Garcia,MichaelP;Wheeler,CosetteM;Kamineni,Aruna;Chao,Chun;Chubak,Jessica;Corley,DouglasA;Owens,ChristopherL;Winer,RachelL;Pruitt,SandiL;Raine-Bennett,Tina;Feldman,Sarah;Silverberg,M
ObjectivesReproducibility of cervical biopsy diagnoses is low and may vary based on where the diagnostic test is performed and by whom. Our objective was to measure multilevel variation in diagnoses across colposcopists, pathologists, and laboratory facilities.MethodsWe cross-sectionally examined variation in cervical biopsy diagnoses within the 5 sites of the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR I) consortium within levels defined by colposcopists, pathologists, and laboratory facilities. Patients aged 18 to 65 years with a colposcopy with biopsy performed were included, with diagnoses categorized as normal, cervical intraepithelial neoplasia grade 1 (CIN1), grade 2 (CIN2), and grade 3 (CIN3). Using Markov Chain Monte-Carlo methods, we fit mixed-effects logistic regression models for biopsy diagnoses and presented median odds ratios (MORs), which reflect the variability within each level. Median odds ratios can be interpreted as the average increased odds a patient would have for a given outcome (eg, CIN2 or CIN3 vs normal or CIN1) when switching to a provider with higher odds of diagnosing that outcome. The MOR is always 1 or greater, and a value of 1 indicates no variation in outcome for that level, with higher values indicating greater variation.Results
