REFERRAL BIAS: SURVIVAL AND PROGNOSTIC FACTORS NIDDM

这篇论文的提案涉及到的程度是 转诊实践中出现的糖尿病患者的临床范围是 与社区中发生的情况相比被扭曲了。这样做的结果 研究将有助于识别和量化出现的扭曲 从推荐偏向的影响中得出有效的推论 从基于转介实践的研究结果来看，这些 这些发现可以适当地与在 社区。此外，这项研究将提供第一个社区 美国II型糖尿病患者存活率的人群研究 各州。而转诊偏见可能会极大地扭曲临床 II型糖尿病的范围，医疗服务研究提出的问题 本论文直接关系到本研究的效度和 转诊中心以患者为基础的研究对许多其他研究的普遍性 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II型糖尿病患者进行比较 II梅奥诊所转诊的糖尿病患者 在7/1/79-6/30/80之间。具体目标将是确定以下方面的程度 两组糖尿病患者存活率的差异 归因于分布的差异和/或 预后因素对II型糖尿病患者生存的影响。 因此，本文将用来评估在多大程度上 与生存特征和预后因素有关的研究 转诊中心对II型糖尿病患者的评估是可以推广的 对在社区实践中接受医疗护理的糖尿病患者 设置。梅奥诊所和罗切斯特医院的独特数据资源 流行病学项目提供了美国唯一的研究环境 能够有效有序地执行这些关键研究的国家 就转介的效果提供必要的、明确的答案 II型糖尿病对临床谱系的偏倚。这种方法论 将与一个论文委员会合作开发，该委员会 非常丰富的这种健康所需的专业知识 服务研究，将作为评价转诊的模式 对许多其他疾病有偏见。

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.