Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging
Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging
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DOI：
10.1111/acem.12625
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发表时间：
2015-04-01
影响因子：
4.4
通讯作者：
Brook, Robert H.
中科院分区：
文献类型：
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作者：
Kanzaria, Hemal K.;Hoffman, Jerome R.;Brook, Robert H.
目的：确定急诊医生(EP)对以下方面的看法：1)他们订购医学上不必要的高级诊断成像的程度，2)导致这种行为的因素，以及3)提出遏制这种行为的解决方案。方法作为一个更大的研究的一部分，吸引医生提供高价值的医疗保健，两个多专业焦点小组被用来探索围绕资源利用的决策主题，之后使用定性分析来产生调查问题。该调查经过了广泛的试点测试，并针对急诊医学(EM)进行了改进，以专注于先进的诊断成像(即计算机断层扫描[CT]或磁共振成像[MRI])。然后对全国有目的的EP和EM受训人员进行了调查。结果在这项研究中，478名急诊科医生完成了调查，其中435名(91%)完成了调查；68%的受访者获得了董事会认证，大约一半的人在学术急诊科工作。超过85%的受访者认为他们自己的急诊室订购了太多的诊断测试，97%的受访者表示，他们个人订购的高级成像研究中至少有一些(平均值=22%)在医学上是不必要的。被认为是主要原因是担心错过低概率的诊断和对诉讼的恐惧。最常被认为对减少不必要的成像非常有帮助的解决方案包括医疗事故改革(79%)，通过教育和共享决策增加患者的参与(70%)和共享决策(56%)，向医生反馈测试排序指标(55%)，以及改善医生对诊断测试的教育(50%)。结论高级成像的过度排序可能是一个系统性问题，因为许多EPs认为大部分此类研究，包括一些他们个人订购的研究，在医学上是不必要的。受访者提到了多个复杂因素和几个潜在的高收益解决方案，必须同时解决这些问题，以遏制过度成像。
ObjectivesThe objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice.MethodsAs part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot-tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]). The survey was then administered to a national, purposive sample of EPs and EM trainees. Simple descriptive statistics to summarize physician responses are presented.ResultsIn this study, 478 EPs were approached, of whom 435 (91%) completed the survey; 68% of respondents were board-certified, and roughly half worked in academic emergency departments (EDs). Over 85% of respondents believe too many diagnostic tests are ordered in their own EDs, and 97% said at least some (mean= 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low-probability diagnosis and fear of litigation. Solutions most commonly felt to be extremely or very helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision-making (56%), feedback to physicians on test-ordering metrics (55%), and improved education of physicians on diagnostic testing (50%).ConclusionsOverordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high-yield solutions that must be addressed simultaneously to curb overimaging.