Durieux Pierre, Ravaud Philippe, Porcher Raphaël, Fulla Yvonne, Manet Catherine-Sophie, Chaussade Stanislas
Department of Public Health and Medical Informatics, Faculté de Médecine Broussais Hôtel Dieu, Paris, France.
Int J Technol Assess Health Care. 2003 Winter;19(1):106-13. doi: 10.1017/s0266462303000102.
To evaluate the long-term impact of an intervention designed to reduce the ordering of three tumor markers frequently prescribed for gastroenterologic diseases (carcinoembryonic antigen, alpha-fetoprotein, carbohydrate antigen 19-9).
A prospective study with time series analysis in a teaching hospital. Local clinical guidelines were developed and implemented through a new order form, designed as a reminder to the physician, restricting the ordering of laboratory tests. Ratios between the number of markers ordered and number of admissions were recorded during a 3-month period before and after intervention in the whole hospital and monthly on a 4-year period in two wards of the hospital (Department of Gastroenterology and Department of Internal Medicine). To evaluate the appropriateness of tumor marker orders, audits were performed on a sample of order forms, before and after (1 month and 2 years after) the implementation of the new order form.
The analysis of covariance showed a significant effect of the intervention in the hospital (p < .01), and in the Departments of Gastroenterology (p < .01) and Internal Medicine (p < .007). The decrease of tumor marker orders ranged from 25% (Internal Medicine Department) to 55% (whole hospital). A similar decrease was observed for the three studied markers. The appropriateness of prescriptions increased from 54.6% before to 73.6% after the implementation of the new order form, but decreased to 52.9% 2 years after intervention.
Providing a reminder to clinicians through a specific order form represents an inexpensive and easy way to implement guidelines on use of laboratory tests.
评估一项旨在减少常用于胃肠疾病的三种肿瘤标志物（癌胚抗原、甲胎蛋白、糖类抗原19-9）开具量的干预措施的长期影响。
在一家教学医院进行一项采用时间序列分析的前瞻性研究。通过一种新的订单形式制定并实施了当地临床指南，该订单形式旨在提醒医生，限制实验室检查的开具。在全院干预前后的3个月期间记录开具的标志物数量与入院人数的比率，并在医院的两个科室（胃肠科和内科）对4年期间每月进行记录。为评估肿瘤标志物订单的合理性，在新订单形式实施之前以及实施之后（1个月和2年后）对订单样本进行审核。
协方差分析显示该干预措施在医院（p < 0.01）、胃肠科（p < 0.01）和内科（p < 0.007）均有显著效果。肿瘤标志物订单的减少幅度从25%（内科）到55%（全院）不等。对三种研究的标志物观察到类似的减少情况。新订单形式实施前处方的合理性为54.6%，实施后增加到73.6%，但干预2年后降至52.9%。
通过特定的订单形式向临床医生提供提醒是实施实验室检查使用指南的一种廉价且简便的方法。
