明智选择前后基层医疗诊所做出的临床决策
Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely.
作者信息
Kost Amanda, Genao Inginia, Lee Jay W, Smith Stephen R
机构信息
From the Department of Family Medicine, University of Washington, Seattle (AK); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (IG); Long Beach Memorial Family Medicine Residency, Long Beach, CA (JWL); and the Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI (SRS).
出版信息
J Am Board Fam Med. 2015 Jul-Aug;28(4):471-4. doi: 10.3122/jabfm.2015.05.140332.
BACKGROUND
The Choosing Wisely campaign encourages physicians to avoid low-value care. Although widely lauded, no study has examined its impact on clinical decisions made in primary care settings.
METHODS
We compared clinical decisions made for 5 Choosing Wisely recommendations over two 6-month time periods before and after the campaign launch and an educational intervention to promote it at 3 primary care residency clinics.
RESULTS
The rate of recommendations adherence was high (93.2%) at baseline but did significantly increase to 96.5% after the launch. These findings suggest primary care physicians respond to training and publicity in low-value care, though further research is needed.
CONCLUSION
Given that even small decreases of physician test ordering can produce large cost savings, the Choosing Wisely project may help achieve the health care triple aim.
背景
明智选择运动鼓励医生避免提供低价值医疗服务。尽管该运动广受赞誉，但尚无研究考察其对基层医疗环境中临床决策的影响。
方法
我们比较了在运动启动前后两个6个月时间段内针对5条明智选择建议所做出的临床决策，以及在3家基层医疗住院医师诊所为推广该运动而进行的教育干预。
结果
基线时建议遵循率很高（93.2%），但运动启动后显著提高到了96.5%。这些发现表明基层医疗医生对低价值医疗服务方面的培训和宣传有反应，不过仍需进一步研究。
结论
鉴于即使医生检查医嘱的小幅减少也能带来大幅成本节约，明智选择项目可能有助于实现医疗保健的三重目标。
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