背景:评估血液透析的肾脏替代疗法对其改善至关重要。值得注意的是,结果因中心而异。此外,使用的方法有重要的认识论局限性,例如忽略重要特征(例如,生活质量)或在指标选择中与患者观点无关。本研究旨在确定利益相关者的意见和偏好(患者,临床医生,和管理者),并确立它们的相对重要性,考虑到它们相互作用的复杂性,促进对血液透析中心的全面评估。
方法:使用多准则方法建立了连续的工作组(WG)。WG1创建了标准和子标准草案,WG2同意,使用具有预先建立的标准的定性结构化分析,WG3由三个面对面的亚组组成(WG3-A,WG3-B,和WG3-C)使用两种方法对它们进行加权:加权和(WS)和层次分析法(AHP)。随后,他们确定了对WS或AHP结果的偏好。最后,通过互联网,WG4通过WG3优选的方法对标准和次级标准进行加权,并且WG5分析结果。
结果:WG1和WG2确定并同意以下评估标准:基于证据的变量(EBV),年发病率,年死亡率,患者报告结果测量(PROMs),和患者报告的经验措施(PREM)。EBV包括五个子标准:血管通路类型,透析剂量,血红蛋白浓度,导管菌血症的比率,和骨矿物质疾病。患者通过互联网在面对面WG3(WS和AHP)和WG4中对PROM进行了比其他利益相关者更大的评价。血管通路的类型是最有价值的次级标准。每个标准和子标准的绩效矩阵被提供作为根据利益相关者的偏好评估结果的参考。
结论:使用多标准方法可以确定指标的相对重要性,反映不同利益相关者的价值观。在性能矩阵中,在评估中纳入价值和无形方面有助于制定临床和组织决策.
BACKGROUND: Evaluation of renal replacement therapy with haemodialysis is essential for its improvement. Remarkably, outcomes vary across centres. In addition, the methods used have important epistemological limitations, such as ignoring significant features (e.g., quality of life) or no relevance given to the patient\'s perspective in the indicator\'s selection. The present study aimed to determine the opinions and preferences of stakeholders (patients, clinicians, and managers) and establish their relative importance, considering the complexity of their interactions, to facilitate a comprehensive evaluation of haemodialysis centres.
METHODS: Successive working groups (WGs) were established using a multicriteria methodology. WG1 created a draft of criteria and sub-criteria, WG2 agreed, using a qualitative structured analysis with pre-established criteria, and WG3 was composed of three face-to-face subgroups (WG3-A, WG3-B, and WG3-C) that weighted them using two methodologies: weighted sum (WS) and analytic hierarchy process (AHP). Subsequently, they determined a preference for the WS or AHP results. Finally, via the Internet, WG4 weighted the criteria and sub-criteria by the method preferred by WG3, and WG5 analysed the results.
RESULTS: WG1 and WG2 identified and agreed on the following evaluation criteria: evidence-based variables (EBVs), annual morbidity, annual mortality, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMs). The EBVs consisted of five sub-criteria: type of vascular access, dialysis dose, haemoglobin concentration, ratio of catheter bacteraemia, and bone mineral disease. The patients rated the PROMs with greater weight than the other stakeholders in both face-to-face WG3 (WS and AHP) and WG4 via the Internet. The type of vascular access was the most valued sub-criterion. A performance matrix of each criterion and sub-criterion is presented as a reference for assessing the results based on the preferences of the stakeholders.
CONCLUSIONS: The use of a multicriteria methodology allows the relative importance of the indicators to be determined, reflecting the values of the different stakeholders. In a performance matrix, the inclusion of values and intangible aspects in the evaluation could help in making clinical and organizational decisions.