Clinical Practice Improvement临床实践改进.ppt

CPI and examples keynote Australia Research Conf 5.31.02 Clinical Practice Improvement A Scientific Methodology to Discover Best Medical Practices by Susan D. Horn Ph.D Institute for Clinical Outcomes Research 2681 Parleys Way, Suite 201 Salt Lake City, Utah 84109 801-466-5595 (V) 801-466-6685 (F) shorn@ Clinical Practice Improvement Study CPI goes beyond outcomes research, which identifies only outcomes is not connected to detailed process steps does not adjust for severity of illness Clinical Practice Improvement Study CPI goes beyond guidelines, which are not decidable: give a vague description of patients not executable: give a menu of process steps to follow not connected to outcomes RCT CPI Adjusts for severityAll patients qualify Clinical Practice Improvementvs.Randomized Controlled Trials How do results from CPI and RCT differ? CPI is a comprehensive analysis of patient, process, and outcome variables CPI studies are based on everyday clinical practice, not controlled circumstances. RCT vs. CPI RCTs are considered to be evidence of the highest grade. Observational (CPI) studies are viewed as having less validity because they reportedly over-estimate treatment effects.* * New England Journal of Medicine 2000; (June 22, 2000) 342:1887-92. RCT vs. CPI Results from 2 new studies “Average results of the observational studies were remarkably similar to those of the randomized, controlled trials.” * New England Journal of Medicine 2000; (June 22, 2000) 342:1878-92. RCT vs. CPI Conclusions Well-designed observational studies do not systematically over-estimate the magnitude of the effects of treatment as compared with those in randomized, controlled trials on the same topic.* * New England Journal of Medicine 2000; (June 22, 2000) 342:1887-92. RCT and CPI Clinical Practice Improvement Study Connects outcomes with detailed process steps Adjusts for severity of illness Pneumonia Criteria Set480.0-486; 506.3; 507.0