基于人口的干预对实验室利用率的影响:时间序列分析分析
C van Walraven1, V Goel, B Chan
1Clinical Epidemiology Unit, Ottawa Hospital, Ontario, Canada. carlv@lri.ca
JAMA
|December 24, 1998
概括
基于人口的干预措施在安大略省显著减少了实验室测试的使用率. 医生指导方针,形式变化和资金政策调整减少了测试量,节省了超过625,000次测试.
科学领域:
- 医疗服务研究 医疗服务研究
- 临床病理学 临床病理学
- 卫生政策 卫生政策
背景情况:
- 以前关于减少实验室利用率的研究往往受限于基于医院,小规模,单一中心或短期的研究.
- 需要有效的策略来减少全民实验室测试利用率.
研究的目的:
- 评估三个基于人口的干预措施对安大略省实验室利用的影响.
- 干预措施包括医生指导方针,实验室要求表格修改和资金政策变化.
主要方法:
- 使用来自安大略省健康保险计划 (1991年7月至1997年4月) 的索赔数据进行了干预时间序列分析.
- 这项研究集中在安大略省医院以外的临床实验室.
- 在干预前后分析了特定实验室测试 (例如,ESR,尿液分析,铁,甲状腺功能) 的利用率.
主要成果:
- 红细胞沉积率 (ESR) 和尿素测定 (分别减少了58%和57%) 的利用率显著下降.
- 微观尿液分析下降了14%,而非微观尿液分析在政策变化后增加了1700%.
- 铁的确定率下降了80%,总甲状腺素下降了96%,甲状腺刺激激素 (TSH) 下降了12%.
- 这些干预措施在1997年4月之前节省了超过625,000项测试和210,400美元.
结论:
- 指南传播,要求表格修改和资助政策变化的结合方法有效地减少了实验室测试的使用率.
- 这些以人口为基础的干预表明了优化实验室资源使用的成功模式.
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