Thinking about health-related outcomes: what do we need evidence about?
Thinking about health-related outcomes: what do we need evidence about?
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DOI：
10.1111/cts.12080
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发表时间：
2013-08
期刊：
影响因子：
--
通讯作者：
Kessler RS
中科院分区：
文献类型：
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作者：
Glasgow RE;Brownson RC;Kessler RS
迫切需要在从预防到姑息治疗的疾病范围内采取有效、公平的干预措施。为了确定这些干预措施并确定其优先次序，需要在与潜在参与者相关的成果中提供对他们很重要的有效性证据。为了为实践和政策提供信息，需要在大多数情况下都可以收集并与公民、从业人员和决策者相关的可采取行动的统一成果的证据。我们建议，应更加优先考虑在多个领域不经常收集的某些结果。普罗克特等人对健康结果的逻辑模型进行了修改，用于提出关键领域和实施措施、服务提供、生物标志物以及健康和功能结果。建议给予更多的优先执行（特别是达到，资源需求/成本;和保真度/适应）;医学研究所的服务提供类别的公平和安全;和病人报告的健康和功能的结果。这一成果框架的影响包括：生物标志物并不总是最重要或最相关的成果;每一种成果都需要采取协调、务实和可操作的措施，需要对培训和赠款及出版物的审查进行重大改革。
There is an urgent need for efficient, equitable interventions across the disease spectrum from prevention to palliative care. To identify and prioritize such interventions, evidence of effectiveness important to potential constituents is needed on outcomes relevant to them. To inform practice and policy, evidence is needed on actionable, harmonized outcomes which are feasible to collect in most settings and relevant to citizens, practitioners and decision makers. We propose that increased priority should be given to certain outcomes that are infrequently collected across multiple domains. A modification of a logic model of health outcomes by Proctor et al. is used to propose key domains and measures of implementation, service delivery, biomarkers, and health and functioning outcomes. Recommendations are made to give increased priority to implementation (especially reach, resource requirements/costs; and fidelity/adaptation); Institute of Medicine service delivery categories of equity and safety; and patient reported health and functioning outcomes. Implications of this outcomes framework include that biomarkers are not always the most important or relevant outcomes; that harmonized, pragmatic and actionable measures are needed for each of these types of outcomes, and that significant changes in training and review of grants and publications are needed.