Verstappen Wim H J M, van Merode Frits, Grimshaw Jeremy, Dubois Willy I, Grol Richard P T M, van der Weijden Trudy
Centre for Quality of Care Research (WOK), Care and Public Health Research Unit (CAPHRI), Department of General Practice, Maastricht University, Maastricht, The Netherlands.
Int J Qual Health Care. 2004 Oct;16(5):391-8. doi: 10.1093/intqhc/mzh070.
To determine the costs and cost reductions of an innovative strategy aimed at improving test ordering routines of primary care physicians, compared with a traditional strategy.
Multicenter randomized controlled trial with randomization at the local primary care physicians group level.
Primary care: local primary care physicians groups in five regions of the Netherlands with diagnostic centers.
Twenty-seven existing local primary care physicians groups, including 194 primary care physicians.
The test ordering strategy was developed systematically, and combined feedback, education on guidelines, and quality improvement sessions in small groups. In regular quality meetings in local groups, primary care physicians discussed each others' test ordering behavior, related it to guidelines, and made individual and/or group plans for change. Thirteen groups engaged in the entire strategy (complete intervention arm), while 14 groups received feedback only (feedback arm).
Running costs, development costs, and research costs were calculated for the intervention period per primary care physician per 6 months. The mean costs of tests ordered per primary care physician per 6 months were assessed at baseline and follow-up.
The new strategy was found to cost 702.00, while the feedback strategy cost 58.00. When including running costs only, the intervention was found to cost 554.70, compared with 17.10 per primary care physician per 6 months in the feedback arm. When excluding opportunity costs for the physicians' time spent, the intervention was found to cost 92.70 per physician per 6 months in the complete intervention arm. The mean costs reduction that physicians in that arm achieved by reducing unnecessary tests was 144 larger per physician per 6 months than the physicians in the feedback arm (P = 0.048).
On the basis of our findings, including the expected non-monetary benefits, we recommend further long-term effect and cost-effect studies on the implementation of the quality strategy.
与传统策略相比，确定旨在改善基层医疗医生检查单开具流程的创新策略的成本及成本降低情况。
在当地基层医疗医生团队层面进行随机分组的多中心随机对照试验。
基层医疗：荷兰五个地区设有诊断中心的当地基层医疗医生团队。
27个现有的当地基层医疗医生团队，包括194名基层医疗医生。
系统制定检查单开具策略，结合反馈、指南教育以及小组质量改进会议。在当地团队的定期质量会议上，基层医疗医生讨论彼此的检查单开具行为，将其与指南进行对照，并制定个人和/或小组改进计划。13个团队参与了整个策略（完全干预组），而14个团队仅接受反馈（反馈组）。
计算干预期间每位基层医疗医生每6个月的运营成本、开发成本和研究成本。在基线和随访时评估每位基层医疗医生每6个月开具检查单的平均成本。
发现新策略成本为702.00，而反馈策略成本为58.00。仅计算运营成本时，干预组成本为554.70，而反馈组每位基层医疗医生每6个月成本为17.10。排除医生花费时间的机会成本后，完全干预组每位医生每6个月成本为92.70。该组医生通过减少不必要检查实现的平均成本降低比反馈组每位医生每6个月多144（P = 0.048）。
基于我们的研究结果，包括预期的非货币效益，我们建议对质量策略的实施进行进一步的长期效果和成本效益研究。
