Trends in the Overuse of Ambulatory Health Care Services in the United States
Trends in the Overuse of Ambulatory Health Care Services in the United States
复制标题
DOI：
10.1001/2013.jamainternmed.1022
复制
发表时间：
2013-01-28
影响因子：
39
通讯作者：
Keyhani, Salomeh
中科院分区：
文献类型：
--
作者：
Kale, Minal S.;Bishop, Tara F.;Keyhani, Salomeh
背景：鉴于医疗保健成本的上升，政策制定者越来越有兴趣找出我们医疗保健系统中的低效之处。这项研究的目的是确定在过去十年中非联邦资助的非门诊医疗服务的过度使用和误用是否有所减少。方法：横断面分析1999和2009年的全国门诊医疗调查和国家医院门诊医疗调查的门诊部部分，这是具有全国代表性的非联邦资助的非门诊医疗服务的年度调查。我们应用了22个质量指标，结合了当前的质量措施和指南建议。主要指标是使用不足、过度使用和误用的比率及其95%的CI。结果：我们观察到9个使用不足质量指标中的6个在统计学上有显著改善。在房颤的抗血栓治疗方面有所改善；在冠状动脉疾病中使用阿司匹林、β-受体阻滞剂和他汀类药物；在充血性心力衰竭中使用β-受体阻滞剂；在糖尿病中使用他汀类药物。我们观察到11个过度使用质量指标中只有2个有所改善，1个指标变差，8个指标没有变化。在65岁以上的妇女就诊时过度使用宫颈癌筛查和在哮喘加重时过度使用抗生素的情况在统计上有显着下降。然而，在74岁以上的男性中，过度使用前列腺癌筛查的情况有所增加。在两个误用指标中，尿路感染患者使用不适当抗生素的比例有所下降。结论：我们发现未充分利用护理的提供有显著改善，但减少不适当护理的变化较有限。由于医疗保健费用高昂，这些结果令人担忧。JAMA实习医生。2013年；173(2)：142-148。2012年12月24日在线发布。DOI：10.1001/2013.jamaintermed.1022
Background: Given the rising costs of health care, policymakers are increasingly interested in identifying the inefficiencies in our health care system. The objective of this study was to determine whether the overuse and misuse of health care services in the ambulatory setting has decreased in the past decade.Methods: Cross-sectional analysis of the 1999 and 2009 National Ambulatory Medical Care Survey and the outpatient department component of the National Hospital Ambulatory Medical Care Survey, which are nationally representative annual surveys of visits to non-federally funded ambulatory care practices. We applied 22 quality indicators using a combination of current quality measures and guideline recommendations. The main outcome measures were the rates of underuse, overuse, and misuse and their 95% CIs.Results: We observed a statistically significant improvement in 6 of 9 underuse quality indicators. There was an improvement in the use of antithrombotic therapy for atrial fibrillation; the use of aspirin, beta-blockers, and statins in coronary artery disease; the use of beta-blockers in congestive heart failure; and the use of statins in diabetes mellitus. We observed an improvement in only 2 of 11 overuse quality indicators, 1 indicator became worse, and 8 did not change. There was a statistically significant decrease in the overuse of cervical cancer screening in visits for women older than 65 years and in the overuse of antibiotics in asthma exacerbations. However, there was an increase in the overuse of prostate cancer screening in men older than 74 years. Of the 2 misuse indicators, there was a decrease in the proportion of patients with a urinary tract infection who were prescribed an inappropriate antibiotic.Conclusions: We found significant improvement in the delivery of underused care but more limited changes in the reduction of inappropriate care. With the high cost of health care, these results are concerning. JAMA Intern Med. 2013;173(2):142-148. Published online December 24, 2012. doi:10.1001/2013.jamainternmed.1022