Eward A M
Office of Clinical Practice Studies, Butterworth Hospital, Grand Rapids, Michigan.
Am Surg. 1991 Nov;57(11):691-6.
The availability of computerized case mix data, which merge medical records information and patient billing data, provide opportunity for measuring physician-specific practice patterns. However, the validity of physician comparisons is a concern when total patient charges are measured at two points in time. In this physician-initiated multicenter study, comparisons using samples of uncomplicated, baseline cases, as determined from medical records chart reviews of five surgical procedures at three institutions, demonstrated a statistically significant reduction in average length of stay (ALOS) from 0.8 to 2.8 in seven of the 15 studies while total patient charges increased in 11 of the studies from one to 29 per cent. Billing data were useful in measuring ALOS and the frequency of specific laboratory tests ordered and then comparing these to physicians' self-report practice.
计算机化病例组合数据将医疗记录信息与患者计费数据相结合，为衡量医生特定的执业模式提供了机会。然而，当在两个时间点测量患者总费用时，医生比较的有效性令人担忧。在这项由医生发起的多中心研究中，通过对三个机构的五种外科手术的医疗记录图表审查确定的简单基线病例样本进行比较，在15项研究中的7项中显示平均住院时间（ALOS）从0.8天显著减少到2.8天，而在11项研究中患者总费用从1%增加到29%。计费数据在测量平均住院时间和特定实验室检查的开具频率以及将这些与医生的自我报告执业情况进行比较方面很有用。
