Couchman Glen R, Forjuoh Samuel N, Reis Michael D, Bartels George, Lindzey David
Departments of Family & Community Medicine, Scott & White Memorial Hospital and Scott, Sherwood, USA.
Med Sci Monit. 2005 Mar;11(3):MT19-25.
The objective of this study was to examine variations in MRI/CT utilization between family physicians (FPs) and general internists (IMs) within a multi-specialty group practice.
MATERIAL/METHODS: Using administrative data, we computed ordering rates of MRI/CT per 1,000 outpatient clinic visits and per 1,000 unique patients and rate ratios (RR) to compare rates between 34 FPs and 24 IMs practicing in 7 clinics located within 50 miles of the radiology facility. We also assessed intra-specialty variation. Sources and degree of variation were determined separately for FPs and IMs through multivariate linear regression modeling.
The IMs ordered MRI/CTs at twice the rate of FPs (29.6 vs. 14.8 per 1,000). Although the absolute ranges by specialty were statistically similar, the variance was significantly higher for IMs (86.1 vs. 52.3; p<0.0001). FPs' ordering rates ranged from 2.8 to 35.2 (SD=7.23), while IMs' ranged from 16.0 to 47.9 (SD=9.27). Female physicians ordered the tests at a higher rate (RR=1.38; 95% CI=1.17-1.53). After controlling for physician gender, years of practice, and patient panel size, distances from their clinics to the radiology facility site and patient severity index were the only variables that were significantly associated with MRI/CT ordering among FPs, explaining 39% of the total variance.
Although IMs ordered MRI/CTs at a higher rate, as were females from both specialties, there was a higher ratio between high and low FP utilizers. The variation in FPs can be partly explained by their clinic distance to the radiology facility site and their patient severity index.
本研究的目的是调查在一个多专科联合诊所中，家庭医生（FPs）和普通内科医生（IMs）在MRI/CT使用方面的差异。
材料/方法：利用管理数据，我们计算了每1000次门诊就诊和每1000名独特患者的MRI/CT开单率以及率比（RR），以比较在距离放射科设施50英里范围内的7家诊所执业的34名家庭医生和24名普通内科医生的开单率。我们还评估了专科内部的差异。通过多元线性回归模型分别确定家庭医生和普通内科医生差异的来源和程度。
普通内科医生开具MRI/CT的比率是家庭医生的两倍（每1000人中有29.6例 vs. 14.8例）。尽管各专科的绝对范围在统计学上相似，但普通内科医生的方差显著更高（86.1 vs. 52.3；p<0.0001）。家庭医生的开单率范围为2.8至35.2（标准差=7.23），而普通内科医生的开单率范围为16.0至47.9（标准差=9.27）。女医生开具这些检查的比率更高（RR=1.38；95%置信区间=1.17-1.53）。在控制了医生性别、执业年限和患者群体规模后，从他们的诊所到放射科设施地点的距离以及患者严重程度指数是与家庭医生开具MRI/CT显著相关的仅有的变量，解释了总方差的39%。
尽管普通内科医生开具MRI/CT的比率更高，两个专科的女性医生也是如此，但家庭医生中高使用者和低使用者之间的比率更高。家庭医生的差异部分可以通过他们的诊所到放射科设施地点的距离以及患者严重程度指数来解释。
