Practice-based evidence study design for comparative effectiveness research
Practice-based evidence study design for comparative effectiveness research
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DOI：
10.1097/mlr.0b013e318070c07b
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发表时间：
2007-10-01
期刊：
影响因子：
3
通讯作者：
Gassaway, Julie
中科院分区：
文献类型：
--
作者：
Horn, Susan D.;Gassaway, Julie
目标：描述一种新的、严格的、全面的基于实践的临床实践改进证据（PBE-CPI）研究方法，并将其特征、优点和缺点与随机对照试验和比较有效性研究的复杂统计方法进行比较。研究设计：PBE-CPI 结合了来自常规临床实践的数据中的自然变化，以确定什么有效、对谁有效、何时有效以及以什么成本。它利用一线护理人员的知识，他们作为跨学科团队的一部分提出研究问题并定义变量。其全面的测量框架为分析治疗和结果之间的显着双变量和多变量关联提供了基础，控制了患者差异，例如疾病的严重程度。结果：PBE-CPI 研究可以比随机对照试验或复杂的统计方法更快地发现更好的实践，同时实现许多相同的优势。我们提供了急性后期护理环境中 PBE-CPI 研究中与药物、营养支持方法、失禁产品、物理治疗活动和其他服务的比较有效性相关的可操作结果的示例。结论：当在实践中采用与 PBE-CPI 分析中更好结果相关的实践时，结果会得到改善。
Objectives: To describe a new, rigorous, comprehensive practice-based evidence for clinical practice improvement (PBE-CPI) study methodology, and compare its features, advantages, and disadvantages to those of randomized controlled trials and sophisticated statistical methods for comparative effectiveness research.Research Design: PBE-CPI incorporates natural variation within data from routine clinical practice to determine what works, for whom, when, and at what cost. It uses the knowledge of front-line caregivers, who develop study questions and define variables as part of a transdisciplinary team. Its comprehensive measurement framework provides a basis for analyses of significant bivariate and multivariate associations between treatments and outcomes, controlling for patient differences, such as severity of illness.Results: PBE-CPI studies can uncover better practices more quickly than randomized controlled trials or sophisticated statistical methods, while achieving many of the same advantages. We present examples of actionable findings from PBE-CPI studies in postacute care settings related to comparative effectiveness of medications, nutritional support approaches, incontinence products, physical therapy activities, and other services.Conclusions: Outcomes improved when practices associated with better outcomes in PBE-CPI analyses were adopted in practice.