Parks C L, Cashman S, Winickoff R N, Bicknell W J
Boston University Health Policy Institute, MA 02215.
Med Care. 1991 Jan;29(1):72-86. doi: 10.1097/00005650-199101000-00007.
This article examines the quality of acute episodic care for five diagnostic categories amenable to one-visit diagnosis and treatment at the nation's largest chain of investor-owned ambulatory care centers. A total of 803 medical records were audited for five common conditions and measured against specific protocols. In four of the five diagnostic categories studied--pharyngitis, otitis media, vaginitis, and use of tetanus immunization--42-97% of patients received care that met or exceeded the standards set by a panel of practicing academic physicians. In follow-up of an incidental high blood pressure reading, however, study physicians met the standard only 24% of the time. Some overprescribing and overtreatment with immunizations were detected. As far as comparison is possible to other studies, results suggest that care in this setting falls within the range of experience that has been reported for other types of practices. In spite of direct economic incentives to increase volume, little evidence was found of overuse of ancillary tests or unnecessary scheduling of repeat visits.
本文考察了美国最大的连锁营利性门诊护理中心针对五类适合一次性诊断和治疗的疾病所提供的急性短期护理质量。针对五种常见病症，共审核了803份病历，并依据特定方案进行衡量。在所研究的五类诊断疾病中，有四类——咽炎、中耳炎、阴道炎以及破伤风免疫接种——42%至97%的患者接受的护理达到或超过了由一组执业学术医师设定的标准。然而，在对偶然测得的高血压读数进行随访时，参与研究的医师仅在24%的情况下达到了标准。研究发现了一些免疫接种方面的过度开药和过度治疗现象。就与其他研究进行比较而言，结果表明这种情况下的护理处于其他类型医疗机构所报告的经验范围内。尽管存在增加诊疗量的直接经济激励措施，但几乎没有证据表明存在辅助检查的过度使用或不必要的复诊安排。
