Davidoff F, Goodspeed R, Clive J
Department of Medicine, New Britain General Hospital, Connecticut.
Med Care. 1989 Jan;27(1):45-58.
A controlled trial of a probabilistic reasoning curriculum to change test ordering behavior was conducted. Twenty-four medical interns in university, veterans, and community hospitals were randomly assigned to "probabilities" or "placebo" groups. Four months after the curriculum sessions, interns in the probabilities group wrote 16% fewer orders for "little ticket" laboratory tests than placebo group interns (P = 0.032). The probabilities group ordered fewer tests than the placebo group at all hospitals, but differences were greatest in the community hospital. Probabilities interns ordered ten of 97 tests significantly less often in the postcurriculum period than at baseline; multitest panels were particularly affected. Placebo curriculum interns ordered three of 97 tests less often in the postcurriculum period. Differences in test ordering were not explained by differences in case mix. Testing rates correlated slightly with case mix and length of stay at baseline; all three measures correlated strongly in the postcurriculum period. Teaching about probabilistic reasoning improves the efficiency of test ordering.
开展了一项关于概率推理课程以改变检查单开具行为的对照试验。大学医院、退伍军人医院和社区医院的24名医学实习生被随机分配到“概率”组或“安慰剂”组。课程结束四个月后，概率组实习生开具的“小额”实验室检查单数量比安慰剂组实习生少16%（P = 0.032）。在所有医院中，概率组开具的检查单都比安慰剂组少，但在社区医院差异最大。概率组实习生在课程结束后开具的97项检查单中有10项比基线时明显减少；多项检查组合受影响尤为明显。安慰剂课程组实习生在课程结束后开具的97项检查单中有3项减少。检查单开具的差异无法用病例组合的差异来解释。检查率在基线时与病例组合和住院时间略有相关；在课程结束后，这三项指标密切相关。关于概率推理的教学提高了检查单开具的效率。
