Attribution of patient reported outcomes to the effects of care providers

直到今年，NHS还没有定期收集从不同医疗保健提供者那里接受不同类型治疗的患者的健康信息。因此，它在履行三项重要职能方面的能力一直受到限制：(1)发现表现良好和表现不佳的医院和一般做法；(2)确定其资源最好用于哪里；(3)在患者可以选择去哪里接受治疗或他们可以接受的治疗类型时，向他们提供有用的信息。关于健康和福祉的信息收集正在迅速向全国各地的所有患者介绍。这可能会显示出提供者和治疗方法之间的巨大差异。这样的差异可能反映了不同提供商在效率和质量方面的差异。然而，不同的人经历的健康水平有很大的差异，与他们所接受的护理几乎没有关系。比较提供者和干预措施在同类产品上的表现。在此基础上，并确保我们确实看到了效果上的差异，我们需要检查相同(或非常相似)患者在接受不同提供者的治疗时结果是如何变化的。有长期健康问题的患者经常从许多不同的提供者那里接受治疗，这一事实使情况变得更加复杂。我们建议使用经济学家最近开发的方法，从我们观察到的个体患者之间的巨大差异中分离出护理提供者的影响。我们将把这些应用于NHS目前正在收集的关于患者结果的数据，以及在最近的其他研究项目中收集的五个数据集。通过比较这六个数据集的结果，我们将能够就需要从患者那里收集的数据量以及如何解释护理提供者之间的差异提出建议。我们的团队包括在不同类型的分析和医学方面拥有专业知识的人员。这些人包括两名负责促进资源有效利用的NHS高级管理人员。他们将确保我们将我们的调查结果有效地传达给当地和国家的决策者。

Until this year, the NHS has not collected information routinely on the health of patients receiving different types of treatments from different health care providers. Consequently, it has been limited in its ability to perform three important functions: (1) spot well-performing and poorly-performing hospitals and general practices; (2) identify where its resources are best spent; and (3) offer useful information to patients when they have a choice of where to go for treatment or of the types of treatment they could receive. The collection of information on health and well-being is being rapidly introduced for all patients across the country. This is likely to show substantial variations between providers and treatments. Variations like these may reflect differences in the effectiveness and quality of different providers. However, there is a substantial amount of variation in levels of health experienced by different individuals that has little or nothing to do with the care they have received. To compare providers and interventions on a ?like-for-like? basis, and be sure we are really seeing variations in effect, we need to examine how the outcomes for the same (or very similar) patients change when they receive treatment from different providers. This is complicated by the fact that patients with long-term health problems often receive treatment from many different providers. We propose to use methods that economists have recently developed to separate out the effects of care providers from the large variation we observe between individual patients. We will apply these to the data that the NHS is currently collecting on patient outcomes and five datasets that have been collected in other recent research projects. By comparing the results across these six datasets, we will be able to make recommendations on the amount of data that needs to be collected from patients and how variations between care providers should be interpreted. Our team involves individuals with expertise in different types of analysis and medicine. These include two senior NHS managers who have responsibility for promoting the effective use of resources. They will ensure we communicate our findings effectively to local and national decision-makers.