需求管理对维生素D测试的影响
Juan José Perales-Afán1,2, Diego Aparicio-Pelaz1, Juan José Puente-Lanzarote1
1Clinical Biochemistry Department, University Hospital Lozano Blesa, Zaragoza, Spain.
Biochemia medica
|June 16, 2025
概括
需求管理策略显著减少了不必要的25-基维生素D (25-OH-D) 测试和医疗保健成本. 修订缺陷切断线也防止了过度诊断,优化了临床和经济结果.
科学领域:
- 临床化学 临床化学
- 实验室医学 实验室医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 25-氧维生素D (25-OH-D) 对和骨健康至关重要,但最佳水平和实验室变化导致临床不确定性和过度测试.
- 过度的25-OH-D测试压迫医疗保健资源,并导致不必要的成本.
研究的目的:
- 评估需求管理策略在减少25-OH-D测试量方面的有效性.
- 评估修订的切断点对维生素D缺乏诊断和成本节约的影响.
- 分析新协议实施后后续测试率的变化.
主要方法:
- 从2015年1月到2024年5月对25-OH-D测试请求的回顾性分析.
- 2022年5月测试需求的年度趋势分析和需求管理规则的实施.
- 评估使用不同切断值 (75,50,30nmol/L) 的维生素D缺乏率,并计算后续检测率.
主要成果:
- 25-OH-D测试从2015年的10830次激增到2023年的85,000次.
- 需求管理导致2022年有12,406次拒绝,2023年有16,809次拒绝,节省了85,600欧元.
- 随访检测率从~15%降至~5%,降低缺陷值使诊断率从>70%降至<50%.
结论:
- 需求管理策略在制不必要的25-OH-D测试和减少医疗保健支出方面是有效的.
- 确定适当的维生素D缺乏的参考值是必要的,以避免高估和改善临床和经济结果.
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