Feedback intervention to reduce routine electrocardiogram use in primary care.
Feedback intervention to reduce routine electrocardiogram use in primary care.
复制标题
反馈干预减少初级保健中常规心电图的使用。
DOI：
10.1016/s0002-8703(03)00107-8
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
Stafford,RandallS
中科院分区：
文献类型：
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作者：
Stafford,RandallS
尽管医生经常要求进行非必要的诊断测试，包括心电图（ECG）等筛查测试，但实现循证测试排序的有效策略尚未得到证实。我们的目的是评估反馈干预的影响，旨在减少筛选心电图的使用率及其variation.METHODSA非随机前后干预试验评估的顺序与马萨诸塞州总医院附属的初级保健提供者之间的心电图。在访问提供者的门诊患者中，排除了心脏病诊断或症状的患者，以及年度访问次数<120次的提供者。数据来自117名供应商，105，682名患者和511，328名患者。在为期9个月的干预期间，提供者定期接受病例组合调整的同行比较其筛选ECG的使用。两个计算机化计费系统跟踪基线（1996年12月至1998年3月），干预（1998年4月至1998年12月）和干预后（1999年1月至1999年9月）ECG的使用。我们的结果指标是：1）门诊就诊时心电图排序的可能性和2）提供者实践差异，由变异系数和四分位数范围表示。干预前4.6%的就诊者排序了ECG。提供者在病例组合调整的ECG排序方面的差异很大（变异系数为101.6%;四分位距为3.2% [1.5%-4.7%]）。干预期间心电图排序平均为3.5%，干预后为2.8%（P < .001）。干预后，ECG排序的变异显著缩小（变异系数，92.5%;四分位距，2.0% [1.0%-3.0%]）。多变量分析证实了一个持久的影响的intervention.CONCLUSIONSFeedback到初级保健提供者成功地减少了心电图的使用及其变化。这种方法可能适用于其他医生的行为，仍然相反的证据，但没有质疑，因为同行比较是不可用的。
BACKGROUNDAlthough physicians frequently order non-essential diagnostic tests, including screening tests such as electrocardiograms (ECGs), effective strategies for achieving evidence-based test-ordering are not proven. Our objective was to evaluate the impact of a feedback intervention designed to reduce the rate of screening ECG use and its variation.METHODSA non-randomized pre-post intervention trial assessed the ordering of ECGs among primary care providers affiliated with Massachusetts General Hospital. Among outpatients visiting providers, those with cardiac diagnoses or symptoms were excluded, as were providers with <120 annual visits. Data were available on 117 providers, 105,682 patients, and 511,328 patient visits. During a 9-month intervention, providers received periodic case-mix-adjusted peer-comparisons of their screening ECG use. Two computerized billing systems tracked baseline (December 1996 to March 1998), intervention (April 1998 to December 1998), and post-intervention (January 1999 to September 1999) ECG use. Our outcome measures were: 1) the likelihood of ECG ordering at office visits and 2) provider practice variation, indicated by coefficient of variation and interquartile range.RESULTSECGs were ordered in 4.6% of visits before the intervention. Provider variation in case-mix adjusted ECG ordering was substantial (coefficient of variation, 101.6%; interquartile range, 3.2% [1.5%-4.7%]). ECG ordering averaged 3.5% during the intervention and 2.8% post-intervention (P < .001). Variation in ECG ordering narrowed considerably (coefficient of variation, 92.5%; interquartile range, 2.0% [1.0%-3.0%]) after the intervention. Multivariate analysis confirmed a persistent impact of the intervention.CONCLUSIONSFeedback to primary care providers successfully reduced ECG use and its variation. This approach may be applicable to other physician behaviors that remain contrary to evidence, but are not questioned because peer comparisons are unavailable.