The meaning of variation to healthcare managers, clinical and health-services researchers, and individual patients
The meaning of variation to healthcare managers, clinical and health-services researchers, and individual patients
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DOI：
10.1136/bmjqs.2010.046334
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发表时间：
2011-04-01
影响因子：
5.4
通讯作者：
Bergman, Bo
中科院分区：
文献类型：
--
作者：
Neuhauser, Duncan;Provost, Lloyd;Bergman, Bo
医疗保健管理人员、临床研究人员和个体患者（以及他们的医生）以不同的方式管理变异，以实现不同的目标。首先，管理人员主要关心的是护理过程的长期绩效。他们的时间范围相对较短，他们所关注的改善是务实和“全面的”。他们的目标是创建稳定有效的流程。统计过程控制的分析技术有效地反映了这些问题。其次，临床和卫生服务研究人员对护理的有效性和研究结果的普遍性感兴趣。他们试图通过他们的研究设计方法来控制变异。他们的主要问题是：“在其他条件相同的情况下，A是否导致了B？因此，随机对照试验和回归模型是首选的研究方法。这种简化主义方法的重点是被观察群体中的“普通患者”，而不是与个人护理提供者一起工作的个体患者。第三，个别患者主要关心自己的护理和临床结果的性质和质量。他们和他们的护理提供者并不主要寻求超越独特个体的概括。我们建议帮助慢性病患者个体的金标准应该是对个体患者进行纵向析因试验设计。了解这三个群体如何不同地处理变异可以帮助欣赏这三种方法。
Healthcare managers, clinical researchers and individual patients (and their physicians) manage variation differently to achieve different ends. First, managers are primarily concerned with the performance of care processes over time. Their time horizon is relatively short, and the improvements they are concerned with are pragmatic and 'holistic.' Their goal is to create processes that are stable and effective. The analytical techniques of statistical process control effectively reflect these concerns. Second, clinical and health-services researchers are interested in the effectiveness of care and the generalisability of findings. They seek to control variation by their study design methods. Their primary question is: 'Does A cause B, everything else being equal?' Consequently, randomised controlled trials and regression models are the research methods of choice. The focus of this reductionist approach is on the 'average patient' in the group being observed rather than the individual patient working with the individual care provider. Third, individual patients are primarily concerned with the nature and quality of their own care and clinical outcomes. They and their care providers are not primarily seeking to generalise beyond the unique individual. We propose that the gold standard for helping individual patients with chronic conditions should be longitudinal factorial design of trials with individual patients. Understanding how these three groups deal differently with variation can help appreciate these three approaches.