Weingarten S, Bolus R, Riedinger M, Selker H, Ellrodt A G
Department of Medicine, Cedars-Sinai Medical Center, UCLA School of Medicine 90048.
Crit Care Med. 1992 Jun;20(6):762-7. doi: 10.1097/00003246-199206000-00011.
Recent concern about escalating healthcare expenditures has prompted healthcare payers and hospitals to identify physicians whose hospital resource consumption exceeds expected norms. The goals of this study were to determine whether analyses of practice patterns in this manner may a) systematically identify older physicians as big resource "spenders," and b) provide misleading information caused by the failure to adjust utilization data for severity of illness.
A prospective, observational study.
The coronary care and intermediate care unit in an 1,100-bed community hospital.
A total of 217 patients hospitalized for chest pain cared for by noncardiologists.
None.
On initial inspection, it appeared that the patients of older physicians had longer lengths of stay and greater charge expenditures than the patients of younger physicians. However, further evaluation demonstrated that older physicians cared for older (76 vs. 67 yrs old, p = .0001) and more severely ill patients (judged by risk of complications, risk of acute ischemic heart disease, and disease staging). Older physicians cared for more severely ill myocardial infarction patients than did younger physicians (Killip Classification 2.0 vs. 1.1, p less than .00003). After adjusting for severity of illness, there were fewer differences in hospital charges and consultant use between older and younger physicians, although the patients of older physicians remained hospitalized longer.
There is little difference in resource utilization between patients cared for by older and younger internists after controlling for severity of illness. This investigation highlights the potential hazards of ignoring severity of illness when judging physician efficiency in the coronary care unit.
近期对医疗保健支出不断攀升的担忧促使医疗保健支付方和医院去找出那些医院资源消耗超出预期标准的医生。本研究的目的是确定以这种方式分析医疗模式是否可能：a）系统性地将年长医生识别为资源“大消费者”；b）因未能针对疾病严重程度调整利用数据而提供误导性信息。
一项前瞻性观察性研究。
一家拥有1100张床位的社区医院的冠心病监护病房和中级护理病房。
共有217名因胸痛住院且由非心脏病专家护理的患者。
无。
初步检查时，年长医生的患者似乎比年轻医生的患者住院时间更长且费用支出更高。然而，进一步评估表明，年长医生护理的是年龄更大（76岁对67岁，p = 0.0001）且病情更严重的患者（根据并发症风险、急性缺血性心脏病风险和疾病分期判断）。年长医生护理的心肌梗死患者比年轻医生护理的病情更严重（Killip分级2.0对1.1，p小于0.00003）。在对疾病严重程度进行调整后，年长医生和年轻医生在医院费用和会诊使用方面的差异较小，尽管年长医生的患者住院时间仍然更长。
在控制疾病严重程度后，年长内科医生和年轻内科医生护理的患者在资源利用方面几乎没有差异。这项调查凸显了在冠心病监护病房评判医生效率时忽视疾病严重程度的潜在危害。
