Heterogeneity Is Not Always Noise Lessons From Improvement

被引：86

作者：

Davidoff, Frank ^{[1
,2
]}

机构：

[1] Annals Internal Med, Philadelphia, PA USA

[2] Inst Healthcare Improvement, Cambridge, MA USA

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2009年 / 302卷 / 23期

关键词：

MEDICAL EMERGENCY TEAM; RAPID RESPONSE TEAM; PATIENT SAFETY RESEARCH; CRITICAL-CARE OUTREACH; QUALITY IMPROVEMENT; CLINICAL-TRIALS; HEALTH-CARE; CODE RATES; MORTALITY; IMPLEMENTATION;

D O I：

10.1001/jama.2009.1845

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Rigorous experimental methods suppress differences among study participants (noise) to detect true intervention effects (signals). But suppressing participants' heterogeneity obscures an essential dimension of biological and clinical knowledge. Medicine is therefore ambivalent about the influence of heterogeneity on outcomes and struggles to find ways to take it properly into account in both clinical practice and research. This analysis explores the roots of that ambivalence. Drawing on the evaluation of 2 health care improvement initiatives, this article examines the unique features of improvement that help to understand heterogeneity's influence on study methods, and suggests a variety of ways to assess the effect of heterogeneity on study outcome measures. JAMA. 2009; 302(23):2580-2586 www.jama.com

引用

页码：2580 / 2586

页数：7

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