人口ベースの介入が実験室の利用に与える影響:タイムシリーズ分析
C van Walraven1, V Goel, B Chan
1Clinical Epidemiology Unit, Ottawa Hospital, Ontario, Canada. carlv@lri.ca
JAMA
|December 24, 1998
まとめ
人口ベースの介入は,オンタリオ州における実験室試験の利用を大幅に削減しました. 医者のガイドライン,フォームの変更,および資金調達政策の調整により,検査量は減少し,625,000件以上の検査を節約しました.
科学分野:
- 医療サービス 研究 医療サービス
- 臨床病理学 臨床病理学とは
- 保健政策 保健政策 保健政策
背景:
- 研究室利用率の削減に関する以前の研究は,しばしば病院内,小規模,単一中心,または短期的なものによって制限されていました.
- 人口全体にわたる実験室試験利用率削減のための効果的な戦略が必要である.
研究 の 目的:
- 3つの集団ベースの介入がオンタリオの実験室利用に与える影響を評価する.
- 介入には,医師のガイドライン,ラボリクエストフォームの変更,および資金調達政策の変更が含まれていました.
主な方法:
- オンタリオ州医療保険プログラム (1991年7月〜1997年4月) の請求データを使用して,介入のタイムシリーズ分析が行われました.
- この研究は,オンタリオ州の病院の外にある臨床実験室に焦点を当てた.
- 特定の実験室検査 (ESR,尿分析,鉄分,甲状腺機能など) の利用率を,介入前後の分析を行った.
主要な成果:
- 赤血球沈殿率 (ESR) と尿素の決定 (それぞれ58%と57%の減少) で,利用率の有意な減少が観察されました.
- 顕微鏡の尿分析は14%減少し,非顕微鏡の尿分析は政策変更後に1700%増加した.
- 鉄の決定は80%,トータルチロキシンは96%,甲状腺刺激ホルモン (TSH) は12%減少した.
- これらの介入により,1997年4月までに62万5千件以上の検査と21万400ドルの節約ができた.
結論:
- ガイドラインの普及,要求書の変更,および資金調達政策の変更を組み合わせたアプローチは,実験室試験の利用を効果的に削減しました.
- これらの集団ベースの介入は,実験室のリソース利用を最適化するための成功したモデルを示しています.
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