知證衛生決策工具之十——評價系統評價結果時應考慮公平性*_《中國循證醫學雜志》

作者：

Andrew D Oxman ¹ , John N Lavis ² , Simon Lewin ³ , Atle Fretheim ⁴

關鍵詞：

DOI：

10.7507/1672-2531.20100418

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本文我們主要討論公平性問題。不公平可以定義為“不必要且可避免的、不公平、不公正的健康差異”。公平性和不公平與社會和經濟因素間的關系已有成熟研究。有效的政策或項目能提高人群總體健康水平。但這些政策及項目對公平性的影響不一：它們可能并不影響公平性問題，也可能減輕或加劇不公平性問題（不論對人群健康的總體影響如何)。
當應用研究證據分析政策或項目方案對弱勢群體及特定環境下公平性問題的潛在影響時，本文建議考慮以下 4 個問題：① 對于正在斟酌的方案，哪些可能是弱勢群體或不利環境？② 針對弱勢群體或不利環境的方案，對其相對效果的預期差異是否有合理解釋？③ 是否不同群體或環境的基線情況有差異，以至方案在弱勢群體或不利環境的絕對效果有差異，或主要問題的重要性不同。④ 是否對實施方案時應注意的問題做了深入思考，以確保減輕（如果可能）或至少不加劇不公平性問題。

引用本文： Andrew D Oxman,John N Lavis,Simon Lewin,Atle Fretheim. 知證衛生決策工具之十——評價系統評價結果時應考慮公平性*. 中國循證醫學雜志, 2010, 10(4): 405-411. doi: 10.7507/1672-2531.20100418 復制

1.	Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst, 2009, 7(Suppl 1): I1.
2.	Oxman AD, Lavis JN, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 1. What is evidence-informed policymaking. Health Res Policy Syst, 2009, 7(Suppl 1): S1.
3.	Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health, 2003, 57: 254-258.
4.	Whitehead M. The concepts and principles of equity and health. Int J Health Serv, 1992, 22: 429-445.
5.	Marmot M. Social determinants of health inequalities. Lancet, 2005, 365: 1099-1104.
6.	Wilkinson R, Marmot M. Social determinants of health. The solid facts 1998 [http://www.euro.who.int/DOCUMENT/E81384.PDF]. Copenhagen: World Health Organization.
7.	Kahn KL, Pearson M, Harrison ER, et al. Analysis of Quality of Care for Patients Who Are Black or Poor in Rural and Urban Settings 1993 [http://www.rand.org/cgi-bin/health/showab.cgi?key=MR- 292-HCFA&year=1993]. Santa Monica: RAND.
8.	Scott J, Marshall G. A dictionary of sociology Oxford: Oxford University Press; 2009.
9.	Howes F, Doyle J, Jackson N, et al. Evidence-based public health: The importance of finding ’difficult to locate’ public health and health promotion intervention studies for systematic reviews. J Public Health, 2004, 26(1): 101-104.
10.	Tugwell P, Maxwell L, Robinson V, et al. Is health equity considered in systematic reviews of the Cochrane Musculoskeletal Group? 15th Cochrane Colloquium, Sao Paulo, Brazil (October, 2007). [http://www.mrw.interscience.wiley.com/cochrane/clcmr/articles/ CMR-11272/frame.html].
11.	Ogilvie D, Petticrew M. Reducing social inequalities in smoking: can evidence inform policy? A pilot study. Tob Control, 2004, 13: 129-131.
12.	Mackenbach JP. Tackling inequalities in health: the need for building a systematic evidence base. J Epidemiol Community Health, 2003, 57: 162.
13.	Gruen R, Bailie R, McDonald E, et al. The potential of systematic reviews to identify diversity and inequity in health care interventions. 11th Cochrane Colloquium, Barcelona, Spain (October, 2003).
14.	Tsikata S, Robinson V, Petticrew M, et al. Do Cochrane systematic reviews contain useful information about health equity? 11th Cochrane Colloquium, Barcelona, Spain (October, 2003) [http:// www.mrw.inter science.wiley.com/cochrane/clcmr/articles/ CMR-5123/frame.html].
15.	Thomson H, Petticrew M, Douglas M. Health impact assessment of housing improvements: incorporating research evidence. J Epidemiol Community Health, 2003, 57: 11-16.
16.	Cooper H, Hedges L. The Handbook of Research Synthesis New York: Russel Sage Foundation; 1994.
17.	Shadish W. Meta-analysis and the exploration of causal mediating processes: A primer of examples, methods, and issues. Psychological Methods, 1996, 1(): 47-65.
18.	Davey SG, Egger M, Phillips AN. Meta-analysis. Beyond the grand mean? BMJ, 1997, 315: 1610-1614.
19.	Thompson S. Why and how sources of heterogeneity should be investigated. In Systematic Reviews in Health Care: Meta-analysis in context Edited by: Egger M, Davey SG, Altman DG. London: BMJ Books; 2001: 157-175.
20.	Deeks JJ, Higgins JPT, Altman DG, Eds. Investigating heterogeneity. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 (updated September 2008) 2008 [http://www. cochrane-hand book.org]. Oxford: Cochrane Collaboration.
21.	Oxman AD, Guyatt G. A consumers’ guide to subgroup analyses. Ann Intern Med, 1992, 116: 78-84.
22.	Guyatt G, Wyer P, Ioannidis J. When to believe a subgroup analysis. In Users’ Guide to the Medical Literature. A Manual for Evidence Based Clinical Practice Edited by: Guyatt G, Rennie D, Meade MO, Cook DJ. New York: McGraw Hill; 2008: 571-593.
23.	Efron B, Morris C. Stein’s paradox in statistics. Scientific American, 1977, 236: 119-127.
24.	Brookes ST, Whitley E, Peters TJ, et al. Subgroup analyses in randomised controlled trials: quantifying the risks of false-positives and false-negatives. Health Technol Assess, 2001, 5: 1-56.
25.	Lavis JN, Oxman AD, Souza NM, et al. SUPPORT Tools for evidence-informed health Policymaking (STP). 9. Assessing the applicability of the findings of a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S9.
26.	Commission on Social Determinants of Health: Closing the gap in a generation: Health equity through action on the social determinants of health 2008 [http://www.who.int/social_determinants/en/ ]. Geneva: World Health Organization.
27.	Hardon A. Ten best readings in ... the Bamako Initiative. Health Policy and Planning, 1990, 5(2): 186-189.
28.	Creese A, Kutzin J. Lessons from cost recovery in health. In Marketizing education and health in developing countries, miracle or mirage? Edited by: Colclough C. Oxford: Clarendon Press; 1997: 37-62.
29.	Ridde V. Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative. Bull World Health Organ, 2003, 81: 532-538.
30.	Austvoll-Dahlgren A, Aaserud M, Vist G, et al. Pharmaceutical policies: effects of cap and copayment on rational drug use. Cochrane Database Syst Rev, 2008, 1: CD007017.
31.	Victora CG, Wagstaff A, Schellenberg JA, et al. Applying an equity lens to child health and mortality: more of the same is not enough. Lancet, 2003, 362: 233-241.

1. Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst, 2009, 7(Suppl 1): I1.
2. Oxman AD, Lavis JN, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 1. What is evidence-informed policymaking. Health Res Policy Syst, 2009, 7(Suppl 1): S1.
3. Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health, 2003, 57: 254-258.
4. Whitehead M. The concepts and principles of equity and health. Int J Health Serv, 1992, 22: 429-445.
5. Marmot M. Social determinants of health inequalities. Lancet, 2005, 365: 1099-1104.
6. Wilkinson R, Marmot M. Social determinants of health. The solid facts 1998 [http://www.euro.who.int/DOCUMENT/E81384.PDF]. Copenhagen: World Health Organization.
7. Kahn KL, Pearson M, Harrison ER, et al. Analysis of Quality of Care for Patients Who Are Black or Poor in Rural and Urban Settings 1993 [http://www.rand.org/cgi-bin/health/showab.cgi?key=MR- 292-HCFA&year=1993]. Santa Monica: RAND.
8. Scott J, Marshall G. A dictionary of sociology Oxford: Oxford University Press; 2009.
9. Howes F, Doyle J, Jackson N, et al. Evidence-based public health: The importance of finding ’difficult to locate’ public health and health promotion intervention studies for systematic reviews. J Public Health, 2004, 26(1): 101-104.
10. Tugwell P, Maxwell L, Robinson V, et al. Is health equity considered in systematic reviews of the Cochrane Musculoskeletal Group? 15th Cochrane Colloquium, Sao Paulo, Brazil (October, 2007). [http://www.mrw.interscience.wiley.com/cochrane/clcmr/articles/ CMR-11272/frame.html].
11. Ogilvie D, Petticrew M. Reducing social inequalities in smoking: can evidence inform policy? A pilot study. Tob Control, 2004, 13: 129-131.
12. Mackenbach JP. Tackling inequalities in health: the need for building a systematic evidence base. J Epidemiol Community Health, 2003, 57: 162.
13. Gruen R, Bailie R, McDonald E, et al. The potential of systematic reviews to identify diversity and inequity in health care interventions. 11th Cochrane Colloquium, Barcelona, Spain (October, 2003).
14. Tsikata S, Robinson V, Petticrew M, et al. Do Cochrane systematic reviews contain useful information about health equity? 11th Cochrane Colloquium, Barcelona, Spain (October, 2003) [http:// www.mrw.inter science.wiley.com/cochrane/clcmr/articles/ CMR-5123/frame.html].
15. Thomson H, Petticrew M, Douglas M. Health impact assessment of housing improvements: incorporating research evidence. J Epidemiol Community Health, 2003, 57: 11-16.
16. Cooper H, Hedges L. The Handbook of Research Synthesis New York: Russel Sage Foundation; 1994.
17. Shadish W. Meta-analysis and the exploration of causal mediating processes: A primer of examples, methods, and issues. Psychological Methods, 1996, 1(): 47-65.
18. Davey SG, Egger M, Phillips AN. Meta-analysis. Beyond the grand mean? BMJ, 1997, 315: 1610-1614.
19. Thompson S. Why and how sources of heterogeneity should be investigated. In Systematic Reviews in Health Care: Meta-analysis in context Edited by: Egger M, Davey SG, Altman DG. London: BMJ Books; 2001: 157-175.
20. Deeks JJ, Higgins JPT, Altman DG, Eds. Investigating heterogeneity. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 (updated September 2008) 2008 [http://www. cochrane-hand book.org]. Oxford: Cochrane Collaboration.
21. Oxman AD, Guyatt G. A consumers’ guide to subgroup analyses. Ann Intern Med, 1992, 116: 78-84.
22. Guyatt G, Wyer P, Ioannidis J. When to believe a subgroup analysis. In Users’ Guide to the Medical Literature. A Manual for Evidence Based Clinical Practice Edited by: Guyatt G, Rennie D, Meade MO, Cook DJ. New York: McGraw Hill; 2008: 571-593.
23. Efron B, Morris C. Stein’s paradox in statistics. Scientific American, 1977, 236: 119-127.
24. Brookes ST, Whitley E, Peters TJ, et al. Subgroup analyses in randomised controlled trials: quantifying the risks of false-positives and false-negatives. Health Technol Assess, 2001, 5: 1-56.
25. Lavis JN, Oxman AD, Souza NM, et al. SUPPORT Tools for evidence-informed health Policymaking (STP). 9. Assessing the applicability of the findings of a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S9.
26. Commission on Social Determinants of Health: Closing the gap in a generation: Health equity through action on the social determinants of health 2008 [http://www.who.int/social_determinants/en/ ]. Geneva: World Health Organization.
27. Hardon A. Ten best readings in ... the Bamako Initiative. Health Policy and Planning, 1990, 5(2): 186-189.
28. Creese A, Kutzin J. Lessons from cost recovery in health. In Marketizing education and health in developing countries, miracle or mirage? Edited by: Colclough C. Oxford: Clarendon Press; 1997: 37-62.
29. Ridde V. Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative. Bull World Health Organ, 2003, 81: 532-538.
30. Austvoll-Dahlgren A, Aaserud M, Vist G, et al. Pharmaceutical policies: effects of cap and copayment on rational drug use. Cochrane Database Syst Rev, 2008, 1: CD007017.
31. Victora CG, Wagstaff A, Schellenberg JA, et al. Applying an equity lens to child health and mortality: more of the same is not enough. Lancet, 2003, 362: 233-241.

《中國循證醫學雜志》

知證衛生決策工具之十——評價系統評價結果時應考慮公平性*

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《中國循證醫學雜志》

知證衛生決策工具之十——評價系統評價結果時應考慮公平性*

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