REFERRAL BIAS: SURVIVAL AND PROGNOSTIC FACTORS NIDDM

转诊偏差：生存和预后因素 NIDDM

• 批准号: 3426972
• 负责人: David J. Ballard
• 金额: $ 2.16万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 1985
• 资助国家: 美国
• 起止时间: 1985-05-01 至 1986-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3426972
• 关键词: cardiovascular disorder epidemiology; community health services; health care professional practice; health care quality; health care referral /consultation; medical records; prognosis

This dissertation proposal is concerned with the degree to which the clinical spectrum of diabetic patients seen in referral practice is distorted compared to that occurring in the community. The results of this research will serve to identify and quantify the distortions which arise from the effects of referral bias so that valid inferences can be drawn from the results of referral-practice based research and so that these findings can be appropriately related to the spectrum of patients seen in the community. In addition, this study will provide the first community population-based study of survival in Type II diabetes in the United States. While referral bias is likely to greatly distort the clinical spectrum of Type II diabetes, the health services research issues raised in this dissertation have direct relevance to the validity and generalizability of referral center patient-based research for many other medical conditions. Specifically, survival characteristics in the Rochester, Minnesota, 1/1/1980 prevalence cohort of Type II diabetics will be compared with Type II diabetic paients from the Mayo Clinic referral practice who were seen between 7/1/79-6/30/80. The specific aim will be to identify the extent to which the differences in survival in the two groups of diabetic patients are attributable to differences in the distribution and/or differences in the effect of prognostic factors for survival in Type II diabetes. Consequently, this dissertation will serve to assess the extent to which studies concerned with survival characteristics and prognostic factor estimation for Type II diabetics seen in referral centers are generalizable to diabetic patients who receive medical care in community practice settings. The unique data resource of the Mayo Clinic and the Rochester Epidemiology Project provides the only research environment in the United States in which these crucial studies can be efficiently executed in order to provide essential definitive answers concerning the effect of referral bias on the clinical spectrum in Type II diabetes. The methodology that will be developed, in collaboration with a Dissertation Committee which is tremendously rich in the expertise necessary for this type of health services research, will serve as a model for the evaluation of referral bias for many other diseases.

本论文的建议是关注的程度， 在转诊实践中看到的糖尿病患者的临床谱是 与社区中发生的情况相比，这是扭曲的。 的结果 研究将有助于确定和量化所产生的扭曲， 从而可以得出有效的推论 从基于实践的研究结果，使这些 结果可以适当地与患者的光谱中看到， 社会各界 此外，这项研究将提供第一个社区， 美国2型糖尿病患者生存率的人群研究 states. 虽然转诊偏倚可能会极大地扭曲临床 II型糖尿病的范围，卫生服务研究中提出的问题， 本论文直接关系到有效性， 转诊中心的普遍性，以患者为基础的研究，为许多其他 医疗条件。 具体来说，明尼苏达州罗切斯特的生存特征， 1980年1月1日II型糖尿病患者的患病率队列将与 来自马约诊所转诊实践的II型糖尿病患者， 79年7月1日到80年6月30日之间。 具体目标将是确定 两组糖尿病患者的生存率差异 可归因于分布的差异和/或 预后因素对II型糖尿病患者生存率的影响。 因此，本论文将有助于评估在多大程度上， 与生存特征和预后因素有关的研究 在转诊中心就诊的II型糖尿病患者的估计值是可推广的 在社区接受医疗护理的糖尿病患者 设置. 马约诊所和罗切斯特的独特数据资源 流行病学项目提供了美国唯一的研究环境， 这些关键研究可以有效地执行， 就转介的影响提供必要的明确答案 对II型糖尿病临床谱的偏倚。 的方法学 将开发，与论文委员会合作，这是 在这类健康所需的专业知识方面非常丰富 服务研究，将作为一个模式，为评价转介 对许多其他疾病的偏见。