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Health Care Science 2024年第3期3卷 151-162页

作者： Gal Av‐Gay anshu parajulee Kathrin Stoll Jude Kornelsen Department of Family Practice Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada

Background:The sustainability of rural surgical and obstetrical facilities depends on their efficacy and quality of care,which are difficult to measure in a rural *** an evaluation of rural practice,it is often the case that the only comparators are larger referral facilities,for which facility‐level comparisons are difficult due to differences in population demographics,acuity of patients,and services *** publication outlines these limitations and highlights a best‐practice approach to making facility‐level comparisons using population‐level data,risk stratification,tests of noninfer-iority,and Firth logistic regression *** includes an investigation of minimum sample‐size requirements through Monte Carlo power analysis in the context of low‐acuity rural surgical ***:Monte Carlo power analysis was used to estimate the minimum sample size required to achieve a power of 0.8 for both logistic regression and Firth logistic regression models that compare the proportion of surgical adverse events against facility type,among other *** provide guidelines for the implementation of a recommended methodology that uses risk stratification,Firth penalized logistic regression,and tests of ***:We illustrate limitations in facility‐level comparison of surgical quality among patients undergoing one of four index procedures including hernia repair,colonoscopy,appendectomy,and cesarean *** identified minimum sample sizes for comparison of each index procedure that fluctuate depending on the level of risk stratification ***:The availability of administrative data can provide an adequate sample size to allow for facility‐level comparisons in surgical quality,at the rural level and *** they are made appropriately,these comparisons can be used to evaluate the efficacy of general practitioners and nurse practitioners in performing low‐acuity procedures.

关键词： evaluation methodology administrative data uses epidemiology cohort analysis

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