多维项目反应理论模型在疾病治疗质量评价中的应用

The Application of Multidimensional Item Response Theory in the Evaluation of Quality of Care

目的利用多维项目反应理论模型评价医院急性心肌梗死和慢性心力衰竭的治疗质量。方法基于多维项目反应理论建立医院急性心肌梗死治疗质量、慢性心力衰竭治疗质量和评价指标使用概率三者的函数关系,利用贝叶斯估计法和马尔可夫链蒙特卡洛(MCMC)方法估计模型参数。结果建立了评价急性心肌梗死和慢性心力衰竭治疗质量的多维项目反应理论模型;通过模型获得了两个相关疾病治疗质量的估计值,同时进行治疗质量的排序;两个相关疾病治疗质量估计值的相关系数为0.789,P<0.0001。结论多维项目反应理论模型适用于相关疾病的治疗质量评价,模型能同时估计多个疾病的治疗质量,并将不同疾病治疗质量间相关性整合进模型,估计更可靠、准确。

Objective Using multidimensional item response theory model to evaluate the quality of care of acute myocardial infarction and chronic heart failure. Methods Based on the multidimensional item response theory, we established a functional relationship among quality of care of acute myocardial infarction and chronic heart failure along with the usage proba- bility of quality indicator. Bayesian estimation method and Markov chain monte carlo （MCMC） method were used to estimate model parameters. Results We established the multidimensional item response theory model which was used to evaluate quality of care of acute myocardial infarction and chronic heart failure ; and attained the estimators of quality of care for the two diseases, then ranked the hospitals by quality of care. The correlation coefficient of quality of care estimators between the two diseases was 0. 789 （P 〈 0. 0001 ）. Conclusion Multidimensional item response theory model is appropriate for evaluating quality of care, it can estimate quality of care for several related diseases simultaneously and integrate the correlation between quality of care of different diseases, and can get more reliable and accurate estimators.