A SUCCESSFUL EXPERIMENT TO REDUCE UNNECESSARY LABORATORY USE IN A COMMUNITY-HOSPITAL
A SUCCESSFUL EXPERIMENT TO REDUCE UNNECESSARY LABORATORY USE IN A COMMUNITY-HOSPITAL
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DOI：
10.1097/00005650-198806000-00011
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发表时间：
1988-06-01
期刊：
影响因子：
3
通讯作者：
TIRRELL, PC
中科院分区：
文献类型：
--
作者：
GORTMAKER, SL;BICKFORD, AF;TIRRELL, PC
一家拥有 228 个床位的综合医院采取了一系列干预措施，定期向医生提供有关用于治疗患者的实验室服务数量的反馈。实验室测试的病例组合调整估计使每位医生能够将实验室测试的使用情况与同一医院同一科室的同行进行比较。具有“过度”执业模式的医生每年会比平均水平多进行数百次实验室检查。多方面的教育计划包括以下内容：1）召开有关费用和不必要的实验室测试的会议； 2) 作为大型和小型部门讨论的一部分，向医生描述了他们相对于同行的实践模式； 3）一年后再次反馈； 4) 共识会议制定了测试排序指南； 5) 检查患者记录样本以确定实验室测试安排的适当性。在基线期间由具有“过度”实践模式的医生进行的测试样本中，总共 37% 被归类为不适当。干预措施使每位患者的测试次数减少了 1.8 次 (P= 0.0005)。九项测试中的八项分别显示了使用量的减少。目标医院的收费数据显示，在计划启动后的一个季度，每名患者的实验室费用在统计上显着降低（P = 0.02），并且没有证据表明五家对比医院发生变化。没有证据表明必要测试的顺序有所减少。这些结果证明了一种具有成本效益的方法，可以在具有集成数据系统的医院中实施，以减少不必要的成本。
A series of interventions at a 228-bed general hospital provided physicians with feedback at regular intervals concerning the amount of laboratory services employed in treating their patients. Case-mix-adjusted estimates of laboratory tests allowed each physician to compare use of laboratory tests with that of peers in the same department at the same hospital. Physicians with “excess” practice patterns ordered hundreds more laboratory tests than average each year. A multifaceted educational program included the following: 1) meetings were held concerning costs and unnecessary laboratory tests; 2) physicians were given descriptions of their practice patterns relative to their peers as part of both large and small departmental discussions; 3) the feedback was repeated a year later; 4) a consensus conference established guidelines for test ordering; and 5) a sample of patient records was examined for appropriateness of laboratory test ordering. A total of 37% of a sample of tests ordered during the baseline period by physicians with “excess” practice patterns was classified as inappropriate. The intervention resulted in a reduction of 1.8 tests per patient (P= 0.0005). Eight of the nine tests individually showed reductions in use. Charge data from the target hospital showed a statistically significant reduction in laboratory charges per patient in the quarter following program initiation (P= 0.02) and no evidence for change in a group of five comparison hospitals. There was no evidence for reductions in the ordering of essential tests. These results demonstrate a cost-effective approach to reducing unnecessary costs that can be implemented in hospitals with integrated data systems.