Morrisroe Kathleen, Nakayama Ayano, Soon Jason, Arnold Mark, Barnsley Les, Barrett Claire, Brooks Peter M, Hall Stephen, Hanrahan Patrick, Hissaria Pravin, Jones Graeme, Katikireddi Veera S, Keen Helen, Laurent Rodger, Nikpour Mandana, Poulsen Katherine, Robinson Philip, Soden Muriel, Wood Nigel, Cook Nicola, Hill Catherine, Buchbinder Rachelle
Department of Rheumatology, St Vincent's Hospital, Sydney, New South Wales, Australia.
Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2018 Feb;48(2):135-143. doi: 10.1111/imj.13654.
The EVOLVE (evaluating evidence, enhancing efficiencies) initiative aims to drive safer, higher-quality patient care through identifying and reducing low-value practices.
To determine the Australian Rheumatology Association's (ARA) 'top five' list of low-value practices.
A working group comprising 19 rheumatologists and three trainees compiled a preliminary list. Items were retained if there was strong evidence of low value and there was high or increasing clinical use and/or increasing cost. All ARA members (356 rheumatologists and 72 trainees) were invited to indicate their 'top five' list from a list of 12-items through SurveyMonkey in December 2015 (reminder February 2016).
A total of 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top five list (percentage of rheumatologists, including item in their top five list) was: Do not perform arthroscopy with lavage and/or debridement for symptomatic osteoarthritis of the knee nor partial meniscectomy for a degenerate meniscal tear (73.2%); Do not order anti-nuclear antibody (ANA) testing without symptoms and/or signs suggestive of a systemic rheumatic disease (56.4%); Do not undertake imaging for low back pain for patients without indications of an underlying serious condition (50.8%); Do not use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection (50.3%) and Do not order anti-double-stranded DNA antibodies in ANA negative patients unless the clinical suspicion of systemic lupus erythematosus remains high (45.3%).
This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low-value practices that should be questioned.
“EVOLVE（评估证据，提高效率）”倡议旨在通过识别和减少低价值医疗行为，推动更安全、更高质量的患者护理。
确定澳大利亚风湿病协会（ARA）低价值医疗行为的“五大”清单。
一个由19名风湿病学家和3名实习医生组成的工作组编制了一份初步清单。如果有确凿证据表明某项行为价值低，且临床使用频率高或不断增加和/或成本不断增加，则保留该项目。2015年12月，通过SurveyMonkey邀请所有ARA成员（356名风湿病学家和72名实习医生）从12项清单中指出他们的“五大”清单（2016年2月提醒）。
共有179名风湿病学家（50.3%）和19名实习医生（26.4%）做出回应。“五大”清单（包括将某项行为列入“五大”清单的风湿病学家的百分比）如下：对于有症状的膝关节骨关节炎，不进行灌洗和/或清创的关节镜检查，对于退变的半月板撕裂不进行部分半月板切除术（73.2%）；在没有提示系统性风湿性疾病的症状和/或体征时，不进行抗核抗体（ANA）检测（56.4%）；对于没有潜在严重疾病迹象的患者，不进行腰痛的影像学检查（50.8%）；不使用超声引导进行肩峰下间隙注射，因为与地标引导注射相比，它没有额外益处（50.3%）；在ANA阴性患者中，除非临床高度怀疑系统性红斑狼疮，否则不进行抗双链DNA抗体检测（45.3%）。
这份清单旨在提高风湿病学家、其他临床医生和患者对应受到质疑的常用低价值医疗行为的认识。
