Ann Intern Med. 2015 Jan 20;162(2):100-8. doi: 10.7326/M14-0694.
Health care reform efforts and initiatives seek to improve quality and reduce costs by eliminating unnecessary care. However, little is known about overuse and its drivers, especially in hospitals.
To assess the extent of and factors associated with overuse of testing in U.S. hospitals.
National survey of practice patterns for 2 common clinical vignettes: preoperative evaluation and syncope. Respondents were randomly selected and randomly provided 1 of 4 versions of each vignette. Each version contained identical clinical information but varied in factors that could change physician behavior. Respondents were asked to identify what they believed most hospitalists at their institution would recommend in each vignette.
Mailed survey conducted from June through October 2011.
Physicians practicing adult hospital medicine in the United States.
Responses indicating overuse (more testing than recommended by American College of Cardiology/American Heart Association guidelines).
68% (1020 of 1500) of hospitalists responded. They reported overuse in 52% to 65% of the preoperative evaluation vignettes and 82% to 85% of the syncope vignettes. Overuse more frequently resulted from a physician's desire to reassure patients or themselves than an incorrect belief that it was clinically indicated (preoperative evaluation, 63% vs. 37%; syncope, 69% vs. 31%; P < 0.001 for each).
Survey responses may not represent actual clinical choices.
Physicians reported substantial overuse in 2 common clinical situations in the hospital. Improving provider knowledge of guidelines may help reduce overuse, but despite awareness of the guidelines, physicians often deviate from them to reassure patients or themselves.
Blue Cross Blue Shield of Michigan Foundation, Department of Veterans Affairs Center for Clinical Management Research, University of Michigan Specialist-Hospitalist Allied Research Program, and Ann Arbor Veterans Affairs/University of Michigan Patient Safety Enhancement Program.
医疗改革的努力和倡议旨在通过消除不必要的医疗来提高质量和降低成本。然而，人们对过度医疗及其驱动因素知之甚少，尤其是在医院。
评估美国医院过度检测的程度和相关因素。
对 2 个常见临床病例的实践模式进行全国性调查：术前评估和晕厥。随机选择受访者，并随机向他们提供每个病例的 4 个版本中的 1 个。每个版本都包含相同的临床信息，但在可能改变医生行为的因素上有所不同。受访者被要求指出他们认为所在机构的大多数医院医生会在每个病例中推荐什么。
2011 年 6 月至 10 月进行的邮寄调查。
在美国从事成人医院医学实践的医生。
表示过度使用（比美国心脏病学会/美国心脏协会指南推荐的更多检测）的回复。
68%（1500 名中的 1020 名）的医院医生做出了回应。他们报告说，在 52%至 65%的术前评估病例和 82%至 85%的晕厥病例中存在过度使用的情况。过度使用更多地是由于医生想要安抚患者或自己的愿望，而不是出于错误地认为这是临床需要（术前评估，63%比 37%；晕厥，69%比 31%；每一项均 P < 0.001）。
调查回复可能无法代表实际的临床选择。
医生报告说，在医院的 2 个常见临床情况下存在大量过度使用的情况。提高提供者对指南的认识可能有助于减少过度使用，但尽管了解了指南，医生往往还是会偏离它们以安抚患者或自己。
密歇根蓝十字蓝盾基金会、退伍军人事务部临床管理研究中心、密歇根大学专家-医院医生联合研究计划以及安阿伯退伍军人事务部/密歇根大学患者安全增强计划。
