在利用审查期间遵守规定的明确标准. 对主治医生和检查医生之间的沟通进行分析
L C Kleinman1, E A Boyd, J C Heritage
1Department of Pediatrics, University of California, Los Angeles, USA. Kleinman@HSPH.Harvard.edu
JAMA
|August 13, 1997
概括
医生审查者比利用审查 (UR) 的既定标准更宽容,经常批准没有指导方针支持的手术. 患者的性别和之前的手术等因素影响了根据明确标准的决定.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗质量保证 医疗质量保证
- 医疗保健政策 医疗保健政策
背景情况:
- 利用审查 (UR) 旨在提高医疗保健质量和成本效益.
- 实际上,UR流程的有效性在很大程度上仍未得到评估.
- 这项研究评估了医生审稿人对UR明确标准的遵守程度.
研究的目的:
- 在利用审查 (UR) 中评估医生评论的结果.
- 为了确定审查者在多大程度上遵循了医学必要性的明确标准.
- 在UR决策中确定影响医生建议的因素.
主要方法:
- 对96份认证前审查成绩单的回顾性分析.
- 医生审查员评估了16岁以下患者的 tympanostomy管插入病例.
- 后勤回归分析了与手术建议和标准偏差相关的因素.
主要成果:
- 审查人员在78%的病例中建议进行手术,但只有29%的病例符合明确的标准或有减轻性情况.
- 所有审查员对手术的建议都符合标准.
- 女性性别 (OR 8.2) 和先前输入管 (OR 30.9) 与偏离标准的建议有关.
结论:
- 医生审查员在利用审查中使用的明确标准相比,表现出宽容.
- 赞成手术的评论员建议始终与既定标准分歧.
- 该研究强调了应用UR指南的潜在不一致性.
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