Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Clin J Am Soc Nephrol. 2012 Oct;7(10):1664-72. doi: 10.2215/CJN.04970512. Epub 2012 Sep 13.
Estimates suggest that one third of United States health care spending results from overuse or misuse of tests, procedures, and therapies. The American Board of Internal Medicine Foundation, in partnership with Consumer Reports, initiated the "Choosing Wisely" campaign to identify areas in patient care and resource use most open to improvement. Nine subspecialty organizations joined the campaign; each organization identified five tests, procedures, or therapies that are overused, are misused, or could potentially lead to harm or unnecessary health care spending. Each of the American Society of Nephrology's (ASN's) 10 advisory groups submitted recommendations for inclusion. The ASN Quality and Patient Safety Task Force selected five recommendations based on relevance and importance to individuals with kidney disease.Recommendations selected were: (1) Do not perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms; (2) do not administer erythropoiesis-stimulating agents to CKD patients with hemoglobin levels ≥10 g/dl without symptoms of anemia; (3) avoid nonsteroidal anti-inflammatory drugs in individuals with hypertension, heart failure, or CKD of all causes, including diabetes; (4) do not place peripherally inserted central catheters in stage 3-5 CKD patients without consulting nephrology; (5) do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians.These five recommendations and supporting evidence give providers information to facilitate prudent care decisions and empower patients to actively participate in critical, honest conversations about their care, potentially reducing unnecessary health care spending and preventing harm.
据估计,美国医疗保健支出的三分之一是由于过度或不当使用检查、程序和疗法造成的。美国内科医师学会基金会与《消费者报告》合作,发起了“明智选择”运动,以确定患者护理和资源利用中最有改进空间的领域。九个专业组织加入了这项运动;每个组织都确定了五项过度使用、误用或可能导致伤害或不必要医疗支出的检查、程序或治疗方法。美国肾脏病学会 (ASN) 的 10 个咨询小组中的每一个都提交了纳入建议。ASN 质量和患者安全工作组根据与肾脏病患者的相关性和重要性,从这些建议中选择了五项建议。选定的建议包括:(1) 对于预期寿命有限且无迹象或症状的透析患者,不要进行常规癌症筛查;(2) 对于血红蛋白水平≥10g/dl 且无贫血症状的 CKD 患者,不要给予促红细胞生成素刺激剂;(3) 避免在有高血压、心力衰竭或任何原因导致的 CKD(包括糖尿病)的个体中使用非甾体抗炎药;(4) 在没有咨询肾脏病医生的情况下,不要在 3-5 期 CKD 患者中放置外周插入中心导管;(5) 在没有确保患者、其家属和医生之间进行共同决策过程的情况下,不要开始慢性透析。这五项建议和支持证据为提供者提供了信息,以促进谨慎的护理决策,并使患者能够积极参与关于其护理的关键、诚实的对话,从而有可能减少不必要的医疗支出并预防伤害。