医疗保险适当使用标准计划:对冠状动脉疾病测试建议的审查
David E Winchester1, Friederike K Keating2, Krishna K Patel3
1Malcom Randall VAMC and University of Florida College of Medicine, Gainesville, Florida (D.E.W.).
Annals of internal medicine
|August 21, 2023
概括
在冠状动脉疾病 (CAD) 中高级成像的适当使用标准 (AUC) 在提供者领导的实体之间显示出显著的差异. 这种异质性可能会给临床医生在选择适当的成像测试时带来不确定性.
科学领域:
- 医疗成像医学成像
- 卫生政策 卫生政策
- 临床决策支持 临床决策支持
背景情况:
- 适当使用标准 (AUC) 计划由国会建立,以尽量减少不必要的高级成像研究.
- 组织可以通过医疗保险和医疗补助服务中心 (CMS) 成为合格的提供者主导实体 (PLEs),以开发AUC.
- 不一致的方法和PLE生成AUC的格式可能会导致临床医生对高级成像测试的适当性感到困惑.
研究的目的:
- 审查CMS合格的PLEs专门为用于诊断冠状动脉疾病 (CAD) 的高级成像测试而开发的AUC.
- CAD被CMS确定为AUC开发的优先临床领域.
主要方法:
- 2022年8月29日,对公开可用的在线数据进行了系统搜索.
- 已批准的AUC文件提供了对CAD测试的建议,被选中进行审查.
- 所有作者都对所选AUC进行了手动审查.
主要成果:
- 在17个CMS合格的PLE中,只有7个发布了与CAD相关的AUC.
- 在这些AUC的方法和格式上发现了显著的变化.
- 涵盖的临床情景和先进成像方法的数量差异很大,许多AUC没有提供任何指导或关于适当性的相互矛盾的建议.
结论:
- 由CMS合格的PLEs开发的CAD高级成像的AUC是不一致的,有时是矛盾的.
- 这种异质性给临床医生带来了显著的不确定性风险,他们的目标是为患者选择最合适的成像测试.
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