The time and financial impact of training fellows in endoscopy. CORI Research Project. Clinical Outcomes Research Initiative.
The time and financial impact of training fellows in endoscopy. CORI Research Project. Clinical Outcomes Research Initiative.
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内窥镜培训人员的时间和财务影响。
DOI：
10.1111/j.1572-0241.2000.03280.x
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
deGarmo,P
中科院分区：
文献类型：
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作者：
McCashland,T;Brand,R;Lyden,E;deGarmo,P
目的：使用国家内窥镜数据库（临床结果研究倡议，CORI）来确定1)同伴介入是否会增加手术时间；2)与私人执业相比，学术中心的同事参与对财务的影响。方法：采用1997年4月1日至1999年4月1日的CORI数据库，比较来自私人诊所、学术医疗中心和退伍军人管理局医院的内镜医师，有无培训研究员。数据在计算机生成的内窥镜检查报告中被捕获，并传输到中央数据库进行分析。记录ASA 1级患者诊断性食管胃十二指肠镜检查（EGD）、EGD合并活检、诊断性结肠镜检查和结肠镜活检的手术时间（分钟）。财务结果采用1999年医疗保险报销率为各自的程序，并计算为4000个程序的理论实践每小时的程序。结果：教师内镜检查增加2-5分钟的EGD，有或没有活检，结肠镜检查增加3-16分钟，有或没有活检。计算内窥镜检查每小时的程序数，在大学环境中使用培训研究员所造成的报销损失将是每小时半个程序。在退伍军人管理局的医院，培训研究员每小时将失去一个完整的程序。在EGD、EGD +活检、结肠镜检查和结肠镜+活检各1000例的模型中，私人执业医生或学术主治医生与涉及培训人员的手术之间的报销差异将为50万美元至100万美元/年。结论：同伴受累使手术时间延长了10-37%。因此，教学机构每小时的偿还减少了，造成了与这些时间承诺有关的财政紧张。
OBJECTIVE:To use a national endoscopy database (Clinical Outcomes Research Initiative, CORI) to determine 1) if fellow involvement increases procedure time; and 2) the financial impact of fellow participation for academic centers compared to private practice.METHODS:CORI database from 4/1/97 to 4/1/99 was used to compare endoscopists from private practices, academic medical centers, and Veterans Administration hospitals, with or without fellows-in-training. Data were captured in a computer-generated endoscopy report and transmitted to a central database for analysis. Duration of procedure (minutes) was recorded for diagnostic esophagogastroduodenoscopy (EGD), EGD with biopsy, diagnostic colonoscopy, and colonoscopy with biopsy, in ASA 1 patients. Financial outcomes used 1999 Medicare reimbursement rates for respective procedures and were calculated as procedures per hour on a theoretical practice of 4000 procedures.RESULTS:Teaching fellows endoscopy added 2–5 min for EGD, with or without biopsy, and 3–16 min for colonoscopy, with or without biopsy. Calculating the number of procedures/h of endoscopy, the reimbursement loss resulting from using fellows-in-training in a university setting would be half a procedure/h. In Veterans Administration hospitals, training of fellows would lose a full procedure/h. In a model of 1000 procedures each of EGD, EGD with biopsy, colonoscopy, and colonoscopy with biopsy, the reimbursement difference between private practice physicians or academic attending physicians and procedures involving fellows-in-training would be $500,000 to $1,000,000/yr.CONCLUSIONS:Fellow involvement prolonged procedure time by 10–37%. Thus, per-hour reimbursement is reduced at teaching institutions, causing financial strain related to these time commitments.