RTI International, Research Triangle Park, NC 27709, USA.
Med Care. 2011 Mar;49(3):287-94. doi: 10.1097/MLR.0b013e318203624f.
This systematic review and meta-analysis examines the effect of screening and brief intervention (SBI) on outpatient, emergency department (ED), and inpatient health care utilization outcomes. Much of the current literature speculates that SBI provides cost savings through reduced health care utilization, but no systematic review or meta-analysis examines this assertion.
Publications were abstracted from online journal collections and targeted Web searches. The systematic review included any publications that examined the association between SBI and health care utilization. Each publication was rated independently by 2 study authors and assigned a consensus methodological score. The meta-analysis focused on those studies examined in the systematic review, but it excluded publications that had incomplete data, low methodological quality, or a cluster-randomized design.
Systematic review results suggest that SBI has little to no effect on inpatient or outpatient health care utilization, but it may have a small, negative effect on ED utilization. A random effects meta-analysis using the Hedges method confirms the ED result for SBI delivered across settings (standardized mean difference = -0.06, I = 13.9%) but does not achieve statistical significance (confidence interval: -0.15, 0.03).
SBI may reduce overall health care costs, but more studies are needed. Current evidence is inconclusive for SBI delivered in ED and non-ED hospital settings. Future studies of SBI and health care utilization should report the estimated effects and variance, regardless of the effect size or statistical significance.
本系统评价和荟萃分析考察了筛查和简短干预（SBI）对门诊、急诊部（ED）和住院医疗保健利用结果的影响。目前的大部分文献推测 SBI 通过减少医疗保健利用来节省成本，但没有系统评价或荟萃分析对此进行检验。
从在线期刊收藏和有针对性的网络搜索中提取出版物。系统评价包括任何考察 SBI 与医疗保健利用之间关联的出版物。每项出版物均由 2 位研究作者独立评估，并分配共识方法评分。荟萃分析侧重于系统评价中检查的那些研究，但排除了数据不完整、方法质量低或采用集群随机设计的出版物。
系统评价结果表明，SBI 对住院或门诊医疗保健利用几乎没有影响，但它可能对 ED 利用有较小的负面影响。采用 Hedges 方法的随机效应荟萃分析证实了在不同环境下实施 SBI 的 ED 结果（标准化均数差=-0.06，I=13.9%），但未达到统计学意义（置信区间：-0.15，0.03）。
SBI 可能会降低整体医疗保健成本，但需要更多的研究。目前，ED 和非 ED 医院环境下实施 SBI 的证据尚无定论。未来 SBI 和医疗保健利用的研究应报告估计的效果和方差，无论效果大小或统计学意义如何。
