Cost Consideration in the Clinical Guidance Documents of Physician Specialty Societies in the United States
Cost Consideration in the Clinical Guidance Documents of Physician Specialty Societies in the United States
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DOI：
10.1001/jamainternmed.2013.817
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发表时间：
2013-06-24
影响因子：
39
通讯作者：
Pearson, Steven D.
中科院分区：
文献类型：
--
作者：
Schwartz, Jennifer A. T.;Pearson, Steven D.
重要性：尽管越来越多的人关注医疗保健的成本，但医生专业学会在制定临床指导文件时对成本的考虑几乎没有得到分析。目的：评估美国30个最大的医生专业协会在2008至2012年间出版的公开临床指导文件和方法学声明中考虑成本的方法。设计：定性文献综述。主要结果和措施：临床指导制定中是否考虑成本，成本考虑的机制，以及成本问题被用于支持特定临床实践推荐的方式。结果：临床指导文件的方法学声明显示，30个医生协会中有17个(57%)明确整合了成本，4(13%)隐含考虑成本，3(10%)有意排除成本，6(20%)没有提及。在明确纳入费用的17个协会中，9个(53%)一贯使用正式系统，其中建议的强度部分受费用的影响，而8个(47%)在方法上不一致或没有提到考虑费用的确切机制。在这些指导文件中包括成本的138项具体建议中，最常见的建议形式(50%[36%])鼓励使用特定的医疗服务，因为具有同等的有效性和更低的成本。结论和相关性：略多于一半的美国最大的医师协会在制定临床指导文件时明确考虑成本；其中，约一半使用明确的机制将成本整合到建议的强度中。许多社会在他们的方法上仍然含糊其辞。医生专业协会应该在影响护理决策的文件中展示更大的透明度和更严格的成本考虑方法。
Importance: Despite increasing concerns regarding the cost of health care, the consideration of costs in the development of clinical guidance documents by physician specialty societies has received little analysis.Objective: To evaluate the approach to consideration of cost in publicly available clinical guidance documents and methodological statements produced between 2008 and 2012 by the 30 largest US physician specialty societies.Design: Qualitative document review.Main Outcomes and Measures: Whether costs are considered in clinical guidance development, mechanism of cost consideration, and the way that cost issues were used in support of specific clinical practice recommendations.Results: Methodological statements for clinical guidance documents indicated that 17 of 30 physician societies (57%) explicitly integrated costs, 4 (13%) implicitly considered costs, 3 (10%) intentionally excluded costs, and 6 (20%) made no mention. Of the 17 societies that explicitly integrated costs, 9 (53%) consistently used a formal system in which the strength of recommendation was influenced in part by costs, whereas 8 (47%) were inconsistent in their approach or failed to mention the exact mechanism for considering costs. Among the 138 specific recommendations in these guidance documents that included cost as part of the rationale, the most common form of recommendation (50 [36%]) encouraged the use of a specific medical service because of equal effectiveness and lower cost.Conclusions and Relevance: Slightly more than half of the largest US physician societies explicitly consider costs in developing their clinical guidance documents; among these, approximately half use an explicit mechanism for integrating costs into the strength of recommendations. Many societies remain vague in their approach. Physician specialty societies should demonstrate greater transparency and rigor in their approach to cost consideration in documents meant to influence care decisions.