Development of explicit criteria for prioritization of hip and knee replacement
Development of explicit criteria for prioritization of hip and knee replacement
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DOI：
10.1111/j.1365-2753.2006.00733.x
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发表时间：
2007-06-01
影响因子：
2.4
通讯作者：
Vidaurreta, Ignacio
中科院分区：
文献类型：
--
作者：
Escobar, Antonio;Quintana, Jose M.;Vidaurreta, Ignacio
理由和目标公共资助的国家卫生服务的问题之一是等待名单。需要择期手术的患者在治疗前通常需要很长的等待时间。我们的目标是为初次髋关节和膝关节置换术开发一种新的优先排序工具。我们召集了一个由九名成员组成的小组，他们对研究团队和患者焦点小组创造的情景进行了评分。我们使用线性和Logistic回归模型研究了专家小组成员之间的一致程度以及变量对专家小组评级的贡献。结果考虑了运动疼痛、行走功能受限、体检异常、休息疼痛、其他功能受限、社会角色和其他可通过关节置换改善的病理7个变量构成不同的情景。该小组对192种情景进行了评分。小组成员之间的分歧非常低(1%)，类内相关系数为0.72。在192个情景中，45.8%被评为紧急，35.4%为首选，18.8%为一般。对得分影响最大的变量是运动疼痛和行走功能限制。当应用最优比例和回归技术时，获得了相似的结果。结论该工具可以评估和优先排序髋关节或膝关节置换的等待名单上的患者。我们还提供了一种简单易用的方法来使用算法来估计单个患者的治疗优先级。
Rationale and aims Among the problems to the publicly funded national health services are the waiting lists. Patients who need elective surgery generally have long waiting times before treatment. We aimed to develop a new prioritization tool for primary hip and knee replacement.Methods Criteria were developed using a modified Delphi panel process. We convened a panel of nine members who scored the scenarios created by the research team and by patient focus groups. We studied the level of agreement among the panelists and the contribution of the variables to the ratings of the panel using linear and logistic regression models. The priority scores of the variables and their levels were synthesized using the optimal scaling and standard linear regression methods.Results Seven variables, pain on motion, walking functional limitations, abnormal findings on physical examination, pain at rest, other functional limitations, social role, and other pathologies that could improve with joint replacement, were considered to create the different scenarios. The panel scored 192 scenarios. The disagreement among the panelists was very low (1%) with an intra-class correlation coefficient of 0.72. Of the 192 scenarios, 45.8% were scored as urgent, 35.4% as preferred and 18.8% as ordinary. The variables that contributed most to the scores were pain on motion and walking functional limitations. When optimal scaling and regression techniques were applied, similar results were obtained.Conclusion This tool can evaluate and prioritize patients on a waiting list for hip or knee replacement. We also provide a simple and easy way to use an algorithm to estimate the treatment priority for individual patients.