Estimation of the Overuse of Preoperative Chest X-rays According to "Choosing Wisely", "No Hacer", and "Essencial" Initiatives: Are They Equally Applicable and Comparable?
Estimation of the Overuse of Preoperative Chest X-rays According to "Choosing Wisely", "No Hacer", and "Essencial" Initiatives: Are They Equally Applicable and Comparable?
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DOI：
10.3390/ijerph17238783
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发表时间：
2020-11-26
影响因子：
--
通讯作者：
Sobrina Working Group
中科院分区：
文献类型：
--
作者：
Vicente-Guijarro J;Valencia-Martín JL;Moreno-Nunez P;Ruiz-López P;Mira-Solves JJ;Aranaz-Andrés JM;Sobrina Working Group
背景：过度使用会降低医疗保健系统的效率并损害患者的安全。不同机构针对术前胸部X光检查的指征发布了建议，但这些建议的遵守程度尚不清楚。本研究调查了这种不当做法的频率和特征。方法：这是一项具有分析成分的描述性观察研究，于 2018 年 7 月至 2019 年 6 月在马德里自治区（西班牙）的一家三级医院进行。根据“明智选择”、“无 Hacer”和“基本”倡议对术前胸部 X 射线检查的不适当性进行了分析，并以相对价值和货币单位估算了与此做法相关的成本。结果：研究期间共进行了 3449 次术前胸部 X 线检查。总的来说，根据“No Hacer”建议，其中 5.4% 是不合理的，根据“明智选择”和“基本”标准，73.3% 是不合理的，这分别相当于不需要进行此测试的干预措施的 5.6% 和 11.8%。超过 20% 的干预措施表明需要进行一次或多次术前胸部 X 光检查，而在过去 3 个月内已经进行过另一次胸部 X 光检查。美国麻醉医师协会 (ASA) 等级 ≥ III 级的干预措施也记录了较高的不适当评分 (16.5%)。麻醉科服务的不适当性得分低于其他呈请手术服务（根据“明智选择”和“基本”，为 57.5%；根据“无 Hacer”，为 4.1%）。根据“No Hacer”标准，胸部 X 光检查的不当指示每年的费用为 52,122.69 欧元（170.1 相对价值单位），根据“明智选择”或“必要”标准，每年费用为 3895.29 欧元（2276.1 相对价值单位）。结论：直接影响发现的不适当程度的建议之间存在很大差异，不适当的主要原因是重复术前胸部X光检查和缺乏考虑胸部干预的特殊性。根据适用的建议，这种不适当性意味着巨大的费用，因此机会成本很高。
Background: Overuse reduces the efficiency of healthcare systems and compromises patient safety. Different institutions have issued recommendations on the indication of preoperative chest X-rays, but the degree of compliance with these recommendations is unknown. This study investigates the frequency and characteristics of the inappropriateness of this practice. Methods: This is a descriptive observational study with analytical components, performed in a tertiary hospital in the Community of Madrid (Spain) between July 2018 and June 2019. The inappropriateness of preoperative chest X-ray tests was analyzed according to “Choosing Wisely”, “No Hacer” and “Essencial” initiatives and the cost associated with this practice was estimated in Relative Value and Monetary Units. Results: A total of 3449 preoperative chest X-ray tests were performed during the period of study. In total, 5.4% of them were unjustified according to the “No Hacer” recommendation and 73.3% according to “Choosing Wisely” and “Essencial” criteria, which would be equivalent to 5.6% and 11.8% of the interventions in which this test was unnecessary, respectively. One or more preoperative chest X-ray(s) were indicated in more than 20% of the interventions in which another chest X-ray had already been performed in the previous 3 months. A higher inappropriateness score was also recorded for interventions with an American Society of Anesthesiologists (ASA) grade ≥ III (16.5%). The Anesthesiology service obtained a lower inappropriateness score than other Petitioning Surgical Services (57.5% according to “Choosing Wisely” and “Essencial”; 4.1% according to “No Hacer”). Inappropriate indication of chest X-rays represents an annual cost of EUR 52,122.69 (170.1 Relative Value Units) according to “No Hacer” and EUR 3895.29 (2276.1 Relative Value Units) according to “Choosing Wisely” or “Essencial” criteria. Conclusions: There was wide variability between the recommendations that directly affected the degree of inappropriateness found, with the main reasons for inappropriateness being duplication of preoperative chest X-rays and the lack of consideration of the particularities of thoracic interventions. This inappropriateness implies a significant expense according to the applicable recommendations and therefore a high opportunity cost.
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影响因子：
39
作者：
Morgan DJ;Dhruva SS;Coon ER;Wright SM;Korenstein D
通讯作者：
Korenstein D
影响因子：
1
作者：
Ramos, Lafayete William Ferreira;Souza, Cristiano F.;Góes, João Carlos Sampaio
通讯作者：
Góes, João Carlos Sampaio
DOI：
10.1007/bf03009471
发表时间：
1993-11-01
期刊：
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
影响因子：
--
作者：
ARCHER, C;LEVY, AR;MCGREGOR, M
通讯作者：
MCGREGOR, M
影响因子：
2.9
作者：
Magid, S.;Forrer, C.;Shaha, S.
通讯作者：
Shaha, S.
影响因子：
4.4
作者：
Kanzaria, Hemal K.;Hoffman, Jerome R.;Brook, Robert H.
通讯作者：
Brook, Robert H.