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Dictionary of Evidence-based Medicine 39 Cost utility analysis (CUA) In this type of economic assessment, the benefits of intervention (e.g. drug or programme) are measured in utility units or utility-weighted life-years. The results are then expressed in terms of cost per utility unit or per utilityweighted life-year. Perhaps the most widely used measure of utility is the quality-adjusted life-year (QALY). Cox proportional hazards model This is one of the most widely used models in survival analysis. The regression model relates time to event (e.g. failure, death, etc.) to a set of descriptor variables (e.g. patients' ages or treatment received). The modelling takes account of the whole survival curve, including censoring. Descriptor variables can be used as part of the regression model or as stratification factors. In the regression model, the effect of a variable is expressed through its impact on the hazard or instantaneous risk of death at any given time (Cox DR (1972) Regression models and life tables. Journal of the Royal Statistical Society B series. 34: 187-220). CRT (see Current procedural terminology) Credibility or credible interval A credibility interval is the Bayesian version of a confidence interval. Its interpretation is more intuitive than that of the classic confidence interval in that it refers to the probability of the parameter of interest being in a preassigned interval, conditional on the observed data. For example, if in a study to estimate what proportion (IT) of patients would respond to a new treatment, we observe that a proportion p^ of a sample of patients responded and report that the associated 95% credibility interval is [a,b], we mean that given the observation p v there is a 95% probability of II being in that interval. The credibility interval is also referred to variously as a (e.g. 95%) posterior probability interval, a (e.g. 95%) highest density region or a (e.g. 95%) Bayesian confidence interval (Lee PM (1989) Bayesian statistics: an introduction. Oxford University Press, New York). Criterion standard (see Gold standard)
40 Dictionary of Evidence-based Medicine Critical incident technique The critical incident technique is a qualitative research method which is particularly useful when the investigator of a complex issue (e.g. prescribing by general practitioners) wishes to understand the reasons for a particular behaviour (e.g. prescribing a new drug instead of an established one). The method uses factual accounts of actual events in which the purpose and consequences of the behaviour are clear (Bradley CP (1992) Uncomfortable prescribing decisions: a critical incident study. BMJ. 304: 294-6. Fitzpatrick R, Boulton M (1994) Qualitative research methods for assessing health care. Quality in Health Care. 3: 107-13). Critical literature appraisal Critical literature appraisal is the application of critical thinking when evaluating the literature. With critical appraisal, the practitioner should be (i) better able to identify reliable and relevant research evidence; (ii) more discriminating in reading; (iii) more consistent in using good quality evidence in decision making; (iv) better able to develop evidence-based services (Milne R, Donald A (1995) Piloting short workshops on the critical appraisal of reviews. Health Trends. 27: 120-3). Critical pathway A critical pathway is a pre-determined case management pathway for hospitalized patients from admission to discharge to ensure optimum outcome in a cost-effective way. Check points and systematic records of each patient's progress are integral components of a critical pathway and these allow subsequent auditing of procedures and outcomes. The care given to the typical uncomplicated patient is organized, sequenced and timed. Critical pathways are developed to facilitate seamless multidisciplinary interaction between different health care workers involved in managing the cases concerned (see Case management, Clinical pathway and Giuliano KK, Poirier CE (1991) Nursing case management: critical pathways to desirable outcomes. Nursing Management. 22: 52-5. Pearson SD, Goulart- Fisher D, Lee TIH (1995) Critical pathways as a strategy for improving care: problems and potential. Annals of Internal Medicine. 123: 941-8). Critical thinking Critical thinking is the systematic evaluation of data presented to us. This requires an ability to interact with and question whatever information is
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Page 4 and 5: Preface This book was conceived at
Page 6 and 7: A Ability to pay Ability to pay is
Page 12 and 13: Figure I Audit: Clinical audit cycl
Page 14 and 15: B Balanced design In an experiment,
Page 66 and 67: Figure 9 Concept of externality Dic
Page 72 and 73: G Game theory Game theory, first de
Page 86 and 87: I ICD (see International Classifica
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K Keynes, John Maynard (1883-1946)
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Dictionary of Evidence-based Medici
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M Macroeconomics Macroeconomics is
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N N of I trial An N of 1 trial is a
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o OBM (see Opinion-based medicine)
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Figure 25 Measuring quality of life
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S Scarcity Scarcity is often referr
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T TDM (see Therapeutic drug monitor
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u Unique value effect This term is
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Z Z variate A random variable which
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