Henke C J, Epstein W V
Department of Medicine, University of California, San Francisco 94143-0920.
Med Care. 1991 Aug;29(8):799-812. doi: 10.1097/00005650-199108000-00012.
This article examines practice variation among rheumatologists in their use of time and procedures in follow-up outpatient encounters with rheumatoid arthritis patients. It focuses on differences across individual physicians rather than differences in populations of patients. In addition, the total variance is divided into parts due to patient characteristics, the providers' economic and other incentives to do procedures or reduce contact time, individual practice styles, and the random sampling of encounters. Data are taken from a stratified random sampling of U.S. rheumatologists. Analyses are based on 1,154 outpatient follow-up encounters with rheumatoid arthritis patients provided by 66 physicians, each of whom reported at least ten such encounters. There are large differences among the physicians in visit length, number of monitoring procedures used per encounter, and whether the encounter included measurements of complete blood count/urinalysis or erythrocyte sedimentation rate. Individual practice style differences are far more important causes of the variation that was observed among providers than are patient differences or practice incentive differences. It was determined that 5-40% of the cost of specific management activities could be saved by reducing the highest use.
本文研究了风湿病医生在对类风湿关节炎患者进行门诊随访时，在时间利用和诊疗程序方面的实践差异。它关注的是个体医生之间的差异，而非患者群体的差异。此外，总差异被分为几个部分，这些部分归因于患者特征、医疗服务提供者进行诊疗程序或减少接触时间的经济及其他激励因素、个体的执业风格，以及随访的随机抽样。数据取自美国风湿病医生的分层随机抽样。分析基于66位医生提供的1154次对类风湿关节炎患者的门诊随访，每位医生至少报告了十次此类随访。医生之间在就诊时长、每次随访使用的监测程序数量，以及随访是否包括全血细胞计数/尿液分析或红细胞沉降率测量方面存在很大差异。个体执业风格差异是观察到的医疗服务提供者之间差异的更重要原因，而非患者差异或执业激励差异。研究确定，通过减少最高使用量，特定管理活动的成本可节省5%至40%。
