{"title":"卓越中心能有多卓越?普遍性对服务质量的影响。","authors":"David Martin Foreman","doi":"10.1177/09514848241270844","DOIUrl":null,"url":null,"abstract":"<p><p>Centres of Excellence (CEs) are thought to provide better quality services for their speciality than Generic Services (GS). However, clinical test theory suggests this may arise from differences in the prevalence of these specialities' conditions in their referral populations, which affects the services' ability to detect diagnoses accurately, even with similar diagnostic sensitivities and specificities. Furthermore, GS' insensitivity to rarer diagnoses is necessary to avoid serious overdiagnosis despite using skills equivalent to CEs. Good GS can perform as well as CEs for disorders of 15% to 20% or greater prevalence in their referral populations, depending on the Minimal Clinically Important Difference (MCID) decided for their diagnoses' positive predictive values or degree of bias. CEs are necessary for rare disorders and have a role in determining MCIDs and the sensitivity and specificity of new measures. Sensitivity, specificity, positive & negative predictive values, and true diagnostic prevalence should be routine outcome measures.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"How excellent can centres of excellence be? The impact of prevalence on service quality.\",\"authors\":\"David Martin Foreman\",\"doi\":\"10.1177/09514848241270844\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Centres of Excellence (CEs) are thought to provide better quality services for their speciality than Generic Services (GS). However, clinical test theory suggests this may arise from differences in the prevalence of these specialities' conditions in their referral populations, which affects the services' ability to detect diagnoses accurately, even with similar diagnostic sensitivities and specificities. Furthermore, GS' insensitivity to rarer diagnoses is necessary to avoid serious overdiagnosis despite using skills equivalent to CEs. Good GS can perform as well as CEs for disorders of 15% to 20% or greater prevalence in their referral populations, depending on the Minimal Clinically Important Difference (MCID) decided for their diagnoses' positive predictive values or degree of bias. CEs are necessary for rare disorders and have a role in determining MCIDs and the sensitivity and specificity of new measures. Sensitivity, specificity, positive & negative predictive values, and true diagnostic prevalence should be routine outcome measures.</p>\",\"PeriodicalId\":45801,\"journal\":{\"name\":\"Health Services Management Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-08-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health Services Management Research\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/09514848241270844\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"HEALTH POLICY & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Services Management Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/09514848241270844","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
引用次数: 0
摘要
卓越中心(Centres of Excellence,CE)被认为比通用服务(Generic Services,GS)为其专科提供了更优质的服务。然而,临床检验理论认为,这可能是由于这些专科的疾病在其转诊人群中的流行率不同,从而影响了服务机构准确检测诊断的能力,即使诊断的敏感性和特异性相似。此外,一般事务人员对较罕见的诊断不敏感,这是避免严重过度诊断的必要条件,尽管他们使用的技能与行政主管相当。对于转诊人群中发病率为 15%至 20%或更高的疾病,优秀的 GS 可与 CE 一样出色,这取决于其诊断的阳性预测值或偏倚程度所决定的最小临床重要差异 (MCID)。对于罕见疾病来说,CE 是必要的,它在确定 MCID 以及新措施的敏感性和特异性方面发挥着作用。灵敏度、特异性、阳性和阴性预测值以及真正的诊断流行率应成为常规结果测量指标。
How excellent can centres of excellence be? The impact of prevalence on service quality.
Centres of Excellence (CEs) are thought to provide better quality services for their speciality than Generic Services (GS). However, clinical test theory suggests this may arise from differences in the prevalence of these specialities' conditions in their referral populations, which affects the services' ability to detect diagnoses accurately, even with similar diagnostic sensitivities and specificities. Furthermore, GS' insensitivity to rarer diagnoses is necessary to avoid serious overdiagnosis despite using skills equivalent to CEs. Good GS can perform as well as CEs for disorders of 15% to 20% or greater prevalence in their referral populations, depending on the Minimal Clinically Important Difference (MCID) decided for their diagnoses' positive predictive values or degree of bias. CEs are necessary for rare disorders and have a role in determining MCIDs and the sensitivity and specificity of new measures. Sensitivity, specificity, positive & negative predictive values, and true diagnostic prevalence should be routine outcome measures.
期刊介绍:
Health Services Management Research (HSMR) is an authoritative international peer-reviewed journal which publishes theoretically and empirically rigorous research on questions of enduring interest to health-care organizations and systems throughout the world. Examining the real issues confronting health services management, it provides an independent view and cutting edge evidence-based research to guide policy-making and management decision-making. HSMR aims to be a forum serving an international community of academics and researchers on the one hand and healthcare managers, executives, policymakers and clinicians and all health professionals on the other. HSMR wants to make a substantial contribution to both research and managerial practice, with particular emphasis placed on publishing studies which offer actionable findings and on promoting knowledge mobilisation toward theoretical advances.