审计和反以改变诊断图像订购实践:系统性审查和元分析
Oluwatosin Badejo1, Maria Saleeb1, Amanda Hall1,2
1Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada.
PloS one
|June 5, 2024
概括
审计和反 (AF) 干预措施适度减少了诊断成像 (DI) 测试订单. 虽然AF在减少整体DI排序方面显示了一些好处,但它对成像测试适宜性的影响仍然不确定.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
- 基于证据的医学基于证据的医学.
背景情况:
- 不必要的诊断成像 (DI) 测试占程序的30%,增加医疗保健成本和患者的风险.
- 审计和反 (AF) 是一种影响医疗保健提供者关于测试订单行为的策略.
研究的目的:
- 系统地审查审计和反 (AF) 干预措施对减少诊断成像 (DI) 测试订单的影响.
- 评估AF对DI订单适当性的影响.
主要方法:
- 通过主要数据库识别的随机对照试验 (RCT) 的系统审查和元分析.
- 包括11个涉及4311名临床医生或实践的RCT.
- 使用Cochrane偏差风险工具评估了偏差风险.
主要成果:
- AF干预导致每1000名患者有1.5个图像测试订单的统计显著减少 (p=0.009).
- AF对DI排序适当性的影响在统计学上并不显著 (p=0.18).
- 证据的强度是适度减少订单和非常低的适当性.
结论:
- 审计和反干预与诊断成像总订单的适度,中度确定性减少有关.
- AF对成像订单的适当性的影响是不确定的,在不同研究中结果非常可变,确定性非常低.
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