Some evaluation needs.
Some evaluation needs.
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一些评估需求。
DOI：
10.1111/j.1749-6632.1993.tb26329.x
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发表时间：
1993
影响因子：
5.2
通讯作者：
Mosteller,F
中科院分区：
文献类型：
--
作者：
Mosteller,F
华盛顿新一届政府的开始是我们停下来思考我们进步的好时机。我们需要评估我们评估医疗干预措施的方法。这一时机恰逢国会要求其技术评估办公室审查评估医疗干预措施的方法。与此同时，保健政策和研究机构正在审查其程序，并考虑哪些新方向可能有助于其今后的工作。然后让我们讨论一些现在正在发生或已经发生的事情，并询问还需要什么。这次会议的目的之一是回顾我们在评估方面的进展。无论我们称之为技术评估，有效性研究，成果研究，还是成本效益分析，参加这次会议的科学企业的目的是提高护理质量，为花费的美元获得更多回报，并改进我们的评估系统。例如，我们将特别期待有关患者结局研究小组（PORTS）的信息，这将为制定未来的评估计划提供新的见解。最近，我听到Wennberg博士谈到临床试验是一系列工具和技术，而不是一种单一的方法，这个概念将在这次会议上进一步解释。他一直强调，满足病人的偏好是医疗保健最重要的目标之一。当然，我们都看到了令人印象深刻的视频方法（患者观看其他患者报告手术或非手术结果的录像带）来解决良性前列腺肥大的问题。这种方法在多大程度上需要扩展到其他医学领域？我对温伯格博士和他的同事们使用的各种方法印象特别深刻。他们研究了使用手术的地区差异，以此来了解哪些情况需要更确切的关于良好治疗的信息。他们使用索赔数据来了解乳房切除术后的死亡和再次手术。他们发现，死亡和再次手术比以前理解的更频繁。然后，为了了解其他结果，研究小组在前列腺切除术前后采访了患者。他们发现，几乎所有症状严重的患者都有改善，在所有患者中，4%的患者术后持续失禁，5%的患者术后阳痿。患者在多大程度上受到他们的条件的困扰方面存在很大差异，这就是为什么患者偏好已成为切除术工作中的主要问题的原因之一。然而，我想强调的是（正如我之前所说的），这个项目是由卫生保健署资助的，资助号为HS 05936。
The beginning of a new administration in Washington is a good time for us to stop and think about our progress. We need to evaluate our methods for assessing health care interventions. The occasion coincides with a moment when Congress has requested its Office of Technology Assessment to review the methods of assessing medical interventions. Simultaneously, the Agency for Health Care Policy and Research is reviewing its procedures and considering what new directions may be helpful in its future work. Let us then discuss some of what is happening now or has gone on and ask what else may be needed. One purpose ofthis conference is to review our progress in making assessments. Whether we call what we do technology assessment, effectiveness research, outcomes research, or cost-benefit analysis, the purposes of the scientific enterprise represented at this meeting are to improve the quality of care, get more payoff for the dollars spent, and to improve our system of evaluation. For example, we will be looking forward especially to information about the Patient Outcomes Research Teams, or PORTS, which should yield new insights into shaping future evaluation programs. Recently I heard Dr. Wennberg speak of clinical trials as a spectrum of tools and techniques rather than as a single method, a concept that will be explained further at this meeting. He has been emphasizing that satisfying patient preference is one of the most important goals of health care. And, of course, we have all seen the impressive video approach (in which patients view a videotape of other patients reporting their outcomes with or without surgery) to the problem of managing benign prostatic hypertrophy. To what extent does this approach need to be extended to other areas of medicine? I have been especially impressed with the variety of methods used by Dr. Wennberg and his colleagues. They studied area variation in usage of operations as a way of appreciating what conditions needed more firm information about good treatment.'They used claims data to find out about deaths and reoperations after prostatectomy.* They found that deaths and reoperations were more frequent than had been previously understood. Then, to find out about other outcomes, the team interviewed patients before and after pro~ tatectomy.~ They found that nearly all patients with severe symptoms had improvements, and among all patients 4 percent had persistent incontinence and 5 percent impotence after surgery. Patients differed greatly in how much they were troubled by their conditions, and this is one reason why patient preference has become such a leading issue in prostatectomy work. What I want to emphasize, however,(as I have earlier4) is a This project is supported by Grant No. HS 05936 from the Agency for Health Care