Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration.
Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration.
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DOI：
10.1186/s13741-022-00265-0
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发表时间：
2022-09-13
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影响因子：
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临床实践指南不鼓励对接受低风险手术的患者进行常规的术前筛查测试。这项研究试图确定在退伍军人健康管理局(VA)接受低风险手术的患者中，潜在低价值的术前筛查测试的频率和成本。使用退伍军人事务部数据仓库，我们确定了2019财年在退伍军人事务部在没有全身麻醉的情况下进行的手术应激评分1级程序(“非常轻微”)，并计算了在手术前30天内接受的9项常见测试的总体国家和设施水平的费率和成本。检查了与接受至少一次筛查测试相关的患者因素，以及接受的测试数量。在178,775例低风险手术中，有86,327例(49.3%)之前进行了321,917项潜在低价值筛查测试，金额为11,505,170美元，使用医疗保险平均成本。最常见的是完全血细胞计数(33.2%)，其次是基础代谢(32.0%)、尿检(26.3%)、心电图(18.9%)和肺功能检查(12.4%)。年龄较大、女性、黑人种族和有更多的合并症与低值检测的几率更高有关。经胸超声心动图仅在4.5%的手术前进行，但占总费用的47.8%(549.9860美元)。在129家退伍军人管理局机构中，至少在一次测试之前进行程序的机构级比例从0到81.2%不等，设施级费用从0美元到388,476美元不等。在一些退伍军人医院，对风险极低的手术进行常规的术前筛查是很常见的，而且费用也很高。这些结果突出了通过减少不必要的护理来提高质量和价值的潜在目标。低价值的围手术期护理措施可以整合到退伍军人管理局广泛的质量监测和改进基础设施中。网上版载有补充材料，可在10.1186/s13741-022-00265-0查阅。
Clinical practice guidelines discourage routine preoperative screening tests for patients undergoing low-risk procedures. This study sought to determine the frequency and costs of potentially low-value preoperative screening tests in Veterans Health Administration (VA) patients undergoing low-risk procedures. Using the VA Corporate Data Warehouse, we identified Operative Stress Score class 1 procedures (“very minor”) performed without general anesthesia in VA during fiscal year 2019 and calculated the overall national and facility-level rates and costs of nine common tests received in the 30 preoperative days. Patient factors associated with receiving at least one screening test, and the number of tests received, were examined. Eighty-six thousand three hundred twenty-seven of 178,775 low-risk procedures (49.3%) were preceded by 321,917 potentially low-value screening tests representing $11,505,170 using Medicare average costs. Complete blood count was the most common (33.2% of procedures), followed by basic metabolic profile (32.0%), urinalysis (26.3%), electrocardiography (18.9%), and pulmonary function test (12.4%). Older age, female sex, Black race, and having more comorbidities were associated with higher odds of low-value testing. Transthoracic echocardiogram occurred prior to only 4.5% of the procedures but accounted for 47.8% of the total costs ($5,499,860). In 129 VA facilities, the facility-level proportion of procedures preceded by at least one test ranged from 0 to 81.2% and facility-level costs ranged from $0 to $388,476. Routine preoperative screening tests for very low-risk procedures are common and costly in some VA facilities. These results highlight a potential target to improve quality and value by reducing unnecessary care. Measures of low-value perioperative care could be integrated into VA’s extensive quality monitoring and improvement infrastructure. The online version contains supplementary material available at 10.1186/s13741-022-00265-0.
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DOI：
10.1590/s1020-49892001000700003
发表时间：
2001-07-01
期刊：
Revista panamericana de salud publica = Pan American journal of public health
影响因子：
--
作者：
Lira, R P;Nascimento, M A;Arieta, C E
通讯作者：
Arieta, C E
影响因子：
14.6
作者：
Kirkham, Kyle R.;Wijeysundera, Duminda N.;Bhatia, R. Sacha
通讯作者：
Bhatia, R. Sacha
影响因子：
13.8
作者：
Mudumbai SC;Pershing S;Bowe T;Kamal RN;Sears ED;Hawn MT;Eisenberg D;Finlay AK;Hagedorn H;Harris AHS
通讯作者：
Harris AHS
影响因子：
158.5
作者：
Schein, OD;Katz, J;Steinberg, EP
通讯作者：
Steinberg, EP
影响因子：
3
作者：
Southern, DA;Quan, H;Ghali, WA
通讯作者：
Ghali, WA