WHICH CRITERIA ARE CONSIDERED IN HEALTHCARE DECISIONS? INSIGHTS FROM AN INTERNATIONAL SURVEY OF POLICY AND CLINICAL DECISION MAKERS
WHICH CRITERIA ARE CONSIDERED IN HEALTHCARE DECISIONS? INSIGHTS FROM AN INTERNATIONAL SURVEY OF POLICY AND CLINICAL DECISION MAKERS
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DOI：
10.1017/s0266462313000573
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发表时间：
2013-10-01
影响因子：
3.2
通讯作者：
Goetghebeur, Mireille M.
中科院分区：
文献类型：
--
作者：
Tanios, Nataly;Wagner, Monika;Goetghebeur, Mireille M.
目的：本研究的目的是收集定性和定量数据的标准考虑的医疗决策者。方法：使用雪球抽样和在线问卷43个标准组织成10个集群，决策者被邀请由一个国际工作队报告的标准，他们认为在他们的背景下，医疗干预措施的决策时。答复者报告了每项标准目前是否得到考虑、是否应当得到考虑及其相对权重（0-5级）。在受访者的比例的差异进行了探讨与推理统计决策水平（微观，中观，宏观），决策者的观点，和世界regions.Results：共有140个决策者（1/3临床，23政策），来自五大洲的23个国家完成了调查。最相关的标准（目前考虑、应考虑和权重排名最高）是临床疗效/有效性、安全性、证据质量、疾病严重程度和对医疗费用的影响。组织和技能要求经常得到考虑，但权重相对较低。对于几乎所有的标准，决策者中认为应该考虑的比例高于认为目前正在考虑的比例（p < .05）。对于超过74%的标准，决策级别、观点和世界地区之间的比例没有统计差异。在几个比较统计显着差异被发现：人口的优先事项，利益相关者的压力/利益，能力，以刺激研究，对伙伴关系和协作的影响，和Environmental impact.Conclusions：结果表明决策者之间的趋同的一套核心标准的相关性，并需要考虑更广泛的标准。分歧的领域似乎主要与背景因素有关。
Objectives: The aim of this study was to gather qualitative and quantitative data on criteria considered by healthcare decision makers.Methods: Using snowball sampling and an online questionnaire with forty-three criteria organized into ten clusters, decision makers were invited by an international task force to report which criteria they consider when making decisions on healthcare interventions in their context. Respondents reported whether each criterion is currently considered, should be considered, and its relative weight (scale 0-5). Differences in proportions of respondents were explored with inferential statistics across levels of decision (micro, meso, macro), decision maker perspectives, and world regions.Results: A total of 140 decision makers (1/3 clinical, 2/3 policy) from 23 countries in five continents completed the survey. The most relevant criteria (top ranked for Currently considered, Should be considered, and weights) were Clinical efficacy/effectiveness, Safety, Quality of evidence, Disease severity, and Impact on healthcare costs. Organizational and skill requirements were frequently considered but had relatively low weights. For almost all criteria, a higher proportion of decision makers reported that they Should be considered than that they are Currently considered (p < .05). For more than 74 percent of criteria, there were no statistical differences in proportions across levels of decision, perspectives and world regions. Statistically significant differences across several comparisons were found for: Population priorities, Stakeholder pressure/interests, Capacity to stimulate research, Impact on partnership and collaboration, and Environmental impact.Conclusions: Results suggest convergence among decision makers on the relevance of a core set of criteria and on the need to consider a wider range of criteria. Areas of divergence appear to be principally related to contextual factors.