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审计,反和提醒信息对初级保健放射学转诊的影响:一项随机试验
M Eccles1, N Steen, J Grimshaw
1Centre for Health Services Research, University of Newcastle upon Tyne, NE2 4AA, Newcastle upon Tyne, UK. martin.eccles@ncl.ac.uk
Lancet (London, England)
|May 18, 2001
概括
教育提醒信息有效地减少了全科医生 (GP) 要求腰椎和膝盖放射图的约20%. 审计和反方法对减少放射性测试使用的影响最小.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 临床放射学 临床放射学
- 一般实践一般实践
背景情况:
- 一般医生经常使用放射性检测,过度使用可能会影响临床管理.
- 英国皇家放射科医师学院的指导方针旨在优化腰椎和膝盖放射图的使用.
研究的目的:
- 评估两个干预措施的有效性 - - 审计和反,以及教育提醒信息 - - 在减少全科医生对放射性检测的要求方面.
- 评估对腰椎和膝盖X射线图的指导方针的遵守情况.
主要方法:
- 一个实用的,集群随机对照试验,232个因子设计,在六个放射科和244个全科医院进行.
- 干预措施包括审计和反,以及附在放射图片上的教育提醒信息.
- 每年每1000名患者的射线图请求率在干预之前和之后被测量,并进行治疗意图分析.
主要成果:
- 教育提醒信息导致腰椎和膝盖X射线扫描请求的显著减少,绝对变化分别为每1000名患者中-1.53和-1.61 (约1. 20%的相对减少).
- 审计和反表明效果很小,腰椎的绝对变化为-0.07,膝关节X射线图的绝对变化为-0.04 (约为0.07). 1%的相对减少).
- 两组之间没有观察到推质量或与指导方针一致性的显著差异.
结论:
- 常规的教育提醒信息有效地减少了全科医生对腰椎和膝盖X射线图的要求,而不会影响转诊质量.
- 六个月的审计数据反在减少X光照请求率方面被证明是无效的.
- 放射科部门可以实施教育提醒信息,以改善从初级保健中适当使用放射性测试.
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