Clinical Decisions with Older Patients: 3rd Experiment

老年患者的临床决策：第三次实验

• 批准号: 6892813
• 负责人: John B McKinlay
• 金额: $ 15.91万
• 依托单位: NEW ENGLAND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-06-01 至 2007-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6892813
• 关键词: British Isles; Germany; United States; age difference; aging; behavioral /social science research tag; cardiovascular disorder diagnosis; clinical research; cognition; coronary disorder; decision making; depression; epidemiology; gender difference; health care policy; health services research tag; human subject; mental disorder diagnosis; patient care management; patient care personnel attitude; primary care physician

DESCRIPTION (provided by applicant): Using an experimental factorial design we have recently demonstrated significant differences between primary care providers in the US and the UK in the clinical management of common medical problems of the elderly (coronary heart disease and depression). These differences are highly significant (most p<.001 ) and unconfounded by patient attributes or physician characteristics. This Competing Continuation will determine whether these exciting health care system differences in clinical decision-making (CDM) are sustained in a third, quite different system (Germany's federalized and corporatized system). Research on health system contributions to variations in CDM obviously requires inclusion of several systems for comparative purposes. Replication of our experiment in a different national setting (Germany) will add scientific confidence to recent findings of system differences in the US and the UK. This research represents a paradigm shift in studies of CDM, by moving the focus from patient attributes (prescriptive CDM) and provider characteristics (descriptive CDM) to a more sociological "third generation" approach (health care system contributions) and to "fourth generation" studies of underlying cognitive (and reasoning) processes. Novel use of a classical experimental (factorial) design (as opposed to observational data) permits unconfounded estimation of different effects. It builds cost-efficiently on work already completed on time and within budget. It has policy implications at the level of patient care, provider training and the organization and financing of medical care. It offers a new explanation for observed international variations in disease rates. The most recent issue of AJPH (February 2003) highlights the urgent need for comparative analyses of different health systems in order to provide policy lessons for the rapidly changing US health care system.

描述（由申请人提供）：通过实验因子设计，我们最近证明了美国和英国的初级保健提供者在老年人常见医疗问题（冠心病和抑郁症）的临床管理方面存在显着差异。这些差异非常显着（大多数p<0.001）并且不受患者属性或医生特征的影响。这种竞争性的延续将决定这些令人兴奋的医疗保健系统在临床决策（CDM）方面的差异是否能够在第三个完全不同的系统（德国的联邦化和公司化系统）中得到维持。研究卫生系统对清洁发展机制变化的贡献显然需要纳入多个系统以进行比较。在不同的国家环境（德国）复制我们的实验将为最近美国和英国系统差异的发现增加科学信心。 这项研究代表了 CDM 研究的范式转变，将重点从患者属性（规定性 CDM）和提供者特征（描述性 CDM）转移到更加社会学的“第三代”方法（医疗保健系统贡献）和“第四代”研究潜在的认知（和推理）过程。经典实验（因子）设计（相对于观察数据）的新颖使用允许对不同效应进行无混杂的估计。它建立在已按时且在预算范围内完成的工作的基础上，具有成本效益。它在患者护理、提供者培训以及医疗保健的组织和融资方面具有政策影响。它为观察到的疾病发病率的国际差异提供了新的解释。最新一期的 AJPH（2003 年 2 月）强调迫切需要对不同卫生系统进行比较分析，以便为快速变化的美国卫生保健系统提供政策教训。