Barazzoni Fabrizio, Grilli Roberto, Amicosante Anna Maria Vincenza, Brescianini Sonia, Marca Michele A, Baggi Marco, Biegger Paul, Renella Rezio
Ente Ospedaliero Cantonale, Viale Officina 3, 6501 Bellinzona, Switzerland.
Int J Qual Health Care. 2002 Aug;14(4):321-7. doi: 10.1093/intqhc/14.4.321.
To assess the impact of health professionals' involvement in the implementation of practice guidelines aimed at reducing the use of pre-operative tests in patients at low anaesthetic risk undergoing elective surgery.
A 6 month (September 1997 to February 1998) strategy based upon organization of local meetings involving health professionals from six hospitals of Canton Ticino (Switzerland).
Observational study (pre/post) of pre-operative test utilization between March 1996 and December 1998.
A total of 17,978 patients admitted for elective surgery over the study period. The latter was modelled in six intervals, three before (baseline), one during, and two after (adoption) guidelines implementation, respectively. For each time interval the proportion of patients undergoing pre-operative tests was estimated. Multilevel logistic regression analysis was used to assess patient likelihood [expressed as the odds ratio (OR)] of undergoing a diagnostic test in each period, using the implementation interval as the reference category.
Change in patient probability of undergoing pre-operative tests in the adoption interval.
Adoption of the recommendations was associated with 81% [OR = 0.19; 95% confidence interval (CI) 0.15-0.23] reduction of patient probability of undergoing coagulation test, 73% (OR = 0.27; 95% CI 0.23-0.33) for glycaemia, 62% (OR = 0.38; 95% CI 0.33-0.44) for azotaemia, 57% (OR = 0.43; 95% CI 0.36-0.51) for chest X-ray, 49% (OR = 0.51; 95% CI 0.44-0.60) for creatinemia, and 43% (OR = 0.57; 95% CI 0.48-0.69) for ECG. Overall, these findings corresponded to a cost saving of 67,890 Swiss francs (US$42,000) for the last quarter under study.
This study indicates that an implementation strategy based upon direct involvement of end users in the identification of possible barriers to change can be successful in promoting the use of practice guidelines.
评估卫生专业人员参与实施旨在减少择期手术中低麻醉风险患者术前检查使用的实践指南的影响。
一项为期6个月（1997年9月至1998年2月）的策略，该策略基于组织来自提契诺州（瑞士）六家医院的卫生专业人员参加的本地会议。
1996年3月至1998年12月期间术前检查利用情况的观察性研究（术前/术后）。
在研究期间，共有17978例患者因择期手术入院。研究期分为六个时间段，分别是指南实施前的三个时间段（基线期）、实施期间的一个时间段和实施后的两个时间段（采用期）。对每个时间段进行术前检查的患者比例进行了估计。采用多水平逻辑回归分析，以实施时间段为参照类别，评估每个时期患者接受诊断检查的可能性[以比值比（OR）表示]。
采用期患者接受术前检查概率的变化。
采用这些建议后，患者接受凝血检查的概率降低了81%[OR = 0.19；95%置信区间（CI）0.15 - 0.23]，血糖检查降低了73%（OR = 0.27；95%CI 0.23 - 0.33），氮质血症检查降低了62%（OR = 0.38；95%CI 0.33 - 0.44），胸部X光检查降低了57%（OR = 0.43；95%CI 0.36 - 0.51），肌酐检查降低了49%（OR = 0.51；95%CI 0.44 - 0.60），心电图检查降低了43%（OR = 0.57；95%CI 0.48 - 0.69）。总体而言，这些结果对应于研究最后一个季度节省了67890瑞士法郎（42000美元）的成本。
本研究表明，基于终端用户直接参与识别变革可能障碍的实施策略，在促进实践指南的应用方面可能是成功的。
