Translating clinical research into clinical practice: Impact of using prediction rules to make decisions
Translating clinical research into clinical practice: Impact of using prediction rules to make decisions
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DOI：
10.7326/0003-4819-144-3-200602070-00009
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发表时间：
2006-02-07
影响因子：
39.2
通讯作者：
Evans, AT
中科院分区：
文献类型：
--
作者：
Reilly, BM;Evans, AT
临床预测规则，有时被称为临床决策规则，近年来激增。然而，很少有经过正式的影响分析，证据标准来评估其对患者护理的影响。没有影响分析，临床医生无法知道使用预测规则是有益还是有害。本文综述了预测规则制定和评价的证据标准；预测规则与决策规则的重要区别在将预测规则转化为决策规则之前，如何评估其潜在的临床影响；对成功的影响分析至关重要的方法学问题，包括确定结果测量和估计样本量；在影响分析之前、期间和之后，临床研究人员和执业临床医生密切合作的重要性；在分析决策规则的临床影响时，需要同时衡量功效和有效性。这些考虑应告知未来的发展，评估和使用所有临床预测或决策规则。
Clinical prediction rules, sometimes called clinical decision rules, have proliferated in recent years. However, very few have undergone formal impact analysis, the standard of evidence to assess their impact on patient care. Without impact analysis, clinicians cannot know whether using a prediction rule will be beneficial or harmful. This paper reviews standards of evidence for developing and evaluating prediction rules; important differences between prediction rules and decision rules; how to assess the potential clinical impact of a prediction rule before translating it into a decision rule; methodologic issues critical to successful impact analysis, including defining outcome measures and estimating sample size; the importance of close collaboration between clinical investigators and practicing clinicians before, during, and after impact analysis; and the need to measure both efficacy and effectiveness when analyzing a decision rule's clinical impact. These considerations should inform future development, evaluation, and use of all clinical prediction or decision rules.