Deyo Richard A
Center for Costs and Outcomes Research, University of Washington, 146 North Canal Street, Suite 300, Seattle, Washington 98103-8652, USA.
Annu Rev Public Health. 2002;23:23-44. doi: 10.1146/annurev.publhealth.23.092101.134534. Epub 2001 Oct 25.
Cascade effect refers to a process that proceeds in stepwise fashion from an initiating event to a seemingly inevitable conclusion. With regard to medical technology, the term refers to a chain of events initiated by an unnecessary test, an unexpected result, or patient or physician anxiety, which results in ill-advised tests or treatments that may cause avoidable adverse effects and/or morbidity. Examples include discovery of endocrine incidentalomas on head and body scans; irrelevant abnormalities on spinal imaging; tampering with random fluctuations in clinical measures; and unwanted aggressive care at the end of life. Common triggers include failing to understand the likelihood of false-positive results; errors in data interpretation; overestimating benefits or underestimating risks; and low tolerance of ambiguity. Excess capacity and perverse financial incentives may contribute to cascade effects as well. Preventing cascade effects may require better education of physicians and patients; research on the natural history of mild diagnostic abnormalities; achieving optimal capacity in health care systems; and awareness that more is not the same as better.
级联效应指的是一个从起始事件逐步发展到看似不可避免的结局的过程。就医疗技术而言，该术语指的是由不必要的检查、意外结果或患者或医生的焦虑引发的一系列事件，这些事件会导致不明智的检查或治疗，可能会造成可避免的不良反应和/或发病率。例子包括在头部和身体扫描中发现内分泌偶发瘤；脊柱成像中的无关异常；对临床测量中的随机波动进行干预；以及在生命末期进行不必要的积极治疗。常见的触发因素包括不理解假阳性结果的可能性；数据解释错误；高估益处或低估风险；以及对不确定性的低容忍度。产能过剩和不正当的经济激励也可能导致级联效应。预防级联效应可能需要对医生和患者进行更好的教育；对轻度诊断异常的自然史进行研究；在医疗保健系统中实现最佳产能；以及认识到更多并不等同于更好。
