Preoperative medical testing in Medicare patients undergoing cataract surgery.
Preoperative medical testing in Medicare patients undergoing cataract surgery.
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DOI：
10.1056/nejmsa1410846
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发表时间：
2015-04-16
期刊：
影响因子：
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通讯作者：
Dudley RA
中科院分区：
文献类型：
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作者：
Chen CL;Lin GA;Bardach NS;Clay TH;Boscardin WJ;Gelb AW;Maze M;Gropper MA;Dudley RA
不建议对接受白内障手术的患者进行常规术前检查，因为检查既不能减少不良事件，也不能改善预后。我们试图评估对该指南的遵守情况，估计潜在不必要的检测的支出，并确定与潜在不必要的检测相关的患者和医疗保健系统特征。使用2011年接受白内障手术的医疗保险受益人的观察队列，我们确定了手术前一个月术前检查的患病率和费用。我们比较了术前检查和门诊的患病率与在前11个月接受检查和门诊的受益人的平均百分比。使用多变量分层分析，我们研究了术前检测与患者特征、卫生系统特征、手术环境、护理团队和术前就诊发生率之间的关系。在440，857名患者中，53%在手术前一个月至少进行了一次术前检查。该月的测试支出比前11个月的平均月支出高出480万美元，办公室访问支出高出1240万美元（分别高出42%和78%）。眼科医生之间的检查差异很大; 36%的眼科医生为超过75%的患者安排了术前检查。患者接受检查的可能性主要与进行术前评估的眼科医生有关。白内障手术前的术前检查频繁发生，与患者特征相比，与提供者实践模式的相关性更强。（由麻醉教育和研究基金会和格罗夫基金会资助。）
Routine preoperative testing is not recommended for patients undergoing cataract surgery, because testing neither decreases adverse events nor improves outcomes. We sought to assess adherence to this guideline, estimate expenditures from potentially unnecessary testing, and identify patient and health care system characteristics associated with potentially unnecessary testing. Using an observational cohort of Medicare beneficiaries undergoing cataract surgery in 2011, we determined the prevalence and cost of preoperative testing in the month before surgery. We compared the prevalence of preoperative testing and office visits with the mean percentage of beneficiaries who underwent tests and had office visits during the preceding 11 months. Using multivariate hierarchical analyses, we examined the relationship between preoperative testing and characteristics of patients, health system characteristics, surgical setting, care team, and occurrence of a preoperative office visit. Of 440,857 patients, 53% had at least one preoperative test in the month before surgery. Expenditures on testing during that month were $4.8 million higher and expenditures on office visits $12.4 million higher (42% and 78% higher, respectively) than the mean monthly expenditures during the preceding 11 months. Testing varied widely among ophthalmologists; 36% of ophthalmologists ordered preoperative tests for more than 75% of their patients. A patient’s probability of undergoing testing was associated mainly with the ophthalmologist who managed the preoperative evaluation. Preoperative testing before cataract surgery occurred frequently and was more strongly associated with provider practice patterns than with patient characteristics. (Funded by the Foundation for Anesthesia Education and Research and the Grove Foundation.)