Cook S S, Cangialose C B, Sieburg D M, Kieszak S M, Boudreau R, Hoffman L H, Elward K S, Ballard D J
Virginia Health Quality Center, Richmond, USA.
Clin Perform Qual Health Care. 1999 Jan-Mar;7(1):5-16.
To assess current practice for red blood cell transfusion relative to the American College of Physicians guideline for red blood cell transfusion; to determine comparative rates and relative appropriateness of autologous versus allogeneic blood use; and, to assess cost implications of current transfusion practices.
Computerized quality-of-care algorithm applied retrospectively to medical-record and blood-bank data.
Twenty-six hospitals in Colorado, Connecticut, Georgia, Oklahoma, and Virginia.
Medicare beneficiaries (2,137) who were hospitalized in 1993 for two elective surgical procedures: total hip arthroplasty and total knee arthroplasty. Of the 1,195 patients who received a preoperative or postoperative transfusion, 728 were excluded from the analysis because the hospital medical record did not contain the clinical documentation necessary to apply the American College of Physicians guideline to each unit transfused. The remaining 467 patients comprised the sample.
For 467 patients who underwent these two procedures and received a total of 651 units of preoperative or postoperative blood, there were 256 excess units transfused. Two hundred four of these units were autologous, and 52 were allogeneic. These excess units accounted for $48,200 of the total $121,000 direct cost of transfused units.
These findings demonstrate that current medical records lack the documentation necessary to evaluate transfusion practice for the majority of Medicare beneficiaries undergoing elective hip and knee arthroplasty. The direct costs of preoperative and postoperative blood transfusion for these two procedures could be reduced by nearly 40% through adherence to the American College of Physicians guideline. The majority of this cost saving would be realized through reduction in unnecessary collection and use of autologous blood.
根据美国医师协会红细胞输注指南评估当前红细胞输注的实践情况；确定自体血与异体血使用的比较率及相对适宜性；并评估当前输血实践的成本影响。
将计算机化的医疗质量算法回顾性应用于病历和血库数据。
科罗拉多州、康涅狄格州、佐治亚州、俄克拉何马州和弗吉尼亚州的26家医院。
1993年因两种择期外科手术住院的医疗保险受益人（2137人）：全髋关节置换术和全膝关节置换术。在1195例接受术前或术后输血的患者中，728例被排除在分析之外，因为医院病历中没有将美国医师协会指南应用于每单位输注血液所需的临床文件。其余467例患者构成样本。
对于接受这两种手术并总共接受651单位术前或术后血液的467例患者，多输注了256单位血液。其中204单位为自体血，52单位为异体血。这些多余的单位占输注单位直接成本121,000美元中的48,200美元。
这些发现表明，当前的病历缺乏评估大多数接受择期髋关节和膝关节置换术的医疗保险受益人的输血实践所需的文件。通过遵循美国医师协会指南，这两种手术术前和术后输血的直接成本可降低近40%。大部分成本节省将通过减少不必要的自体血采集和使用来实现。
