Demertzis Jennifer L, Rubin David A
Division of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri.
Semin Musculoskelet Radiol. 2017 Feb;21(1):9-16. doi: 10.1055/s-0036-1597249. Epub 2017 Mar 2.
In the United States, health care costs are spiraling upward at an unsustainable rate. Concurrently, medical specialties, legislatures, and the population each recognize the need to prove that current medical practices are effective, measured by outcomes. These forces necessitate a change in radiology's role, from emphasizing interpretation and reporting to maintaining and demonstrating quality and value. An important part of this task involves establishing the appropriateness of imaging tests by application of objective data and expert opinion in an effort to optimize resource utilization and modality selection. We explore the justifications for establishing appropriateness use criteria, various paradigms that have been applied to their creation, inherent limitations of appropriateness rules based on imperfect data, and challenges associated with their widespread implementation and utilization. An appendix of key terms that may be unfamiliar to radiologists is included for future reference.
在美国，医疗保健成本正以不可持续的速度螺旋式上升。与此同时，医学专科、立法机构和民众都认识到有必要证明当前的医疗实践是有效的，这要通过结果来衡量。这些因素使得放射学的角色需要发生转变，从强调解读和报告转向维护和展示质量与价值。这项任务的一个重要部分涉及通过应用客观数据和专家意见来确定影像检查的适宜性，以努力优化资源利用和检查方式的选择。我们探讨了确立适宜性使用标准的理由、应用于其制定的各种模式、基于不完美数据的适宜性规则的固有局限性，以及与它们广泛实施和应用相关的挑战。附录中包含了放射科医生可能不熟悉的关键术语，以供未来参考。
