队列研究和CER-AHRQ.ppt

Copyright H Photography 2006 iS Pragmatic cohort studies and comparative effectiveness Eric S Johnson, PhD Kaiser Permanente’s Center for Effectiveness and Safety Research AHRQ’s Effective Healthcare Program: Scientific Resource Center June 18, 2010 UC Davis School of Medicine /Drama/family/JeevesandWooster/picturegallery.html Copyright Matt Knannlein 2005 iStockP The risk of death associated with the use of conventional versus atypical antipsychotics among elderly patients Sebastian Schneeweiss, Soko Setoguchi, Alan Brookhart, Colin Dormuth, Philip S Wang Canadian Medical Association Journal 2007;176:627-32 Copyright Matt Knannlein 2005 iStockP BMJ’s PICO format: Study question Do conventional antipsychotic drugs pose risks equal to or greater than those associated with newer, atypical drugs in an elderly population? Copyright Matt Knannlein 2005 iStockP BMJ’s PICO format: Design, intervention and control We conducted a retrospective cohort study of elderly patients with a diagnosis of dementia who started a conventional or an atypical antipsychotic drug. Copyright Matt Knannlein 2005 iStockP BMJ’s PICO format: Participants and setting We followed 37,241 patients 65 years or older who started an antipsychotic drug between 1996 and 2004 and were residents of British Columbia. Copyright Matt Knannlein 2005 iStockP BMJ’s PICO format: Outcomes and their timing We compared the 180-day all-cause mortality rate for patients who started conventional versus atypical antipsychotic drugs. Copyright Matt Knannlein 2005 iStockP BMJ’s PICO format: Results and role of chance Of the 24,359 (control cohort) patients who started an atypical antipsychotic drug, 9.6% died by 180 days. In adjusted analyses, patients who started a conventional drug were 32% more likely to die (hazard ratio=1.32; 95% CI, 1.23 to 1.42)— an excess of 3.5 deaths per 100 patients. Copyright Matt Knannlein 2005 iStockP A pragmatic-explanatory continuum indic