Specialties performing paracentesis procedures at university hospitals: implications for training and certification.
Specialties performing paracentesis procedures at university hospitals: implications for training and certification.
复制标题
在大学医院进行腹腔穿刺术的专业：对培训和认证的影响。
DOI：
10.1002/jhm.2153
复制
发表时间：
2014
影响因子：
2.6
通讯作者：
D. Wayne
中科院分区：
文献类型：
--
作者：
J. Barsuk;J. Feinglass;S. Kozmic;S. Hohmann;D. Ganger;D. Wayne
背景
内科或家庭医学委员会认证不需要穿刺术程序能力，国家数据显示，这些程序越来越多地涉及介入放射学（IR）。然而，大学医院的实践模式不太清楚。
目的
评估哪些专科在大学医院进行穿刺术，比较每个专科内患者的特征，并评估住院时间（LOS）和住院费用。
设计、环境、患者
对2010年1月至2012年12月在参与大学健康系统联盟（UHC）数据库的医院接受穿刺术的肝病患者进行观察性管理数据库审查。UHC是由120个学术医疗中心及其290家附属医院组成的联盟。
暴露
接受住院穿刺术的肝病患者。
测量
我们比较了接受穿刺术的患者的特点，由医生专业，建模的影响，患者的特点对IR转诊的可能性。我们还分析了预测IR转诊概率>20%的患者的LOS和住院费用。
结果
在204家医院的70，862次住院期间进行了97，577次穿刺手术。IR进行了29%的穿刺术，而医学和医学亚专业（包括胃肠病学/肝病学）进行了49%的穿刺术。女性、肥胖和疾病严重程度较低的患者更有可能被转诊至IR。与IR相比，药物或胃肠病学/肝病穿刺术患者的LOS相似。与IR手术相比，住院费用估计为药物少1308美元，胃肠病学/肝病少803美元（均P = 0.0001）。
结论
内科和家庭医学培训的临床医生经常对复杂的住院病人进行穿刺手术，但目前不要求他们能够胜任该手术。增加床旁穿刺术可以降低医疗费用。
BACKGROUND
Paracentesis procedure competency is not required for internal medicine or family medicine board certification, and national data show these procedures are increasingly referred to interventional radiology (IR). However, practice patterns at university hospitals are less clear.
OBJECTIVE
To evaluate which specialties perform paracentesis procedures at university hospitals, compare characteristics of patients within each specialty, and evaluate length of stay (LOS) and hospital costs.
DESIGN, SETTING, PATIENTS
Observational administrative database review of patients with liver disease who underwent paracentesis procedures in hospitals participating in the University HealthSystem Consortium (UHC) Database from January 2010 through December 2012. UHC is an alliance of 120 academic medical centers and their 290 affiliated hospitals.
EXPOSURE
Patients with liver disease who underwent inpatient paracentesis procedures.
MEASUREMENTS
We compared characteristics of patients who underwent paracentesis procedures by physician specialty, modeling the effects of patient characteristics on the likelihood of IR referral. We also analyzed LOS and hospital costs among patients with a >20% predicted probability of IR referral.
RESULTS
There were 97,577 paracentesis procedures performed during 70,862 hospital stays in 204 hospitals. IR performed 29% of paracenteses versus 49% by medicine and medicine subspecialties including gastroenterology/hepatology. Patients who were female, obese, and those with lower severity of illness were more likely to be referred to IR. Patients with a medicine or gastroenterology/hepatology paracentesis had a similar LOS compared to IR. Hospital costs were an estimated as $1308 less for medicine and $803 less for gastroenterology/hepatology compared to admissions with IR procedures (both P = 0.0001).
CONCLUSIONS
Internal medicine- and family medicine-trained clinicians frequently perform paracentesis procedures on complex inpatients but are not currently required to be competent in the procedure. Increasing bedside paracentesis procedures may reduce healthcare costs.
影响因子：
7.2
作者：
ROMANO, PS;ROOS, LL;JOLLIS, JG
通讯作者：
JOLLIS, JG