Cook David A, Pencille Laurie J, Dupras Denise M, Linderbaum Jane A, Pankratz V Shane, Wilkinson John M
Knowledge Delivery Center, Mayo Clinic, Rochester, Minnesota, United States of America.
Mayo Clinic Online Learning, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America.
PLoS One. 2018 Jan 31;13(1):e0191943. doi: 10.1371/journal.pone.0191943. eCollection 2018.
To understand clinicians' beliefs about practice variation and how variation might be reduced.
We surveyed board-certified physicians (N = 178), nurse practitioners (N = 60), and physician assistants (N = 12) at an academic medical center and two community clinics, representing family medicine, general internal medicine, and cardiology, from February-April 2016. The Internet-based questionnaire ascertained clinicians' beliefs regarding practice variation, clinical practice guidelines, and costs.
Respondents agreed that practice variation should be reduced (mean [SD] 4.5 [1.1]; 1 = strongly disagree, 6 = strongly agree), but agreed less strongly (4.1 [1.0]) that it can realistically be reduced. They moderately agreed that variation is justified by situational differences (3.9 [1.2]). They strongly agreed (5.2 [0.8]) that clinicians should help reduce healthcare costs, but agreed less strongly (4.4 [1.1]) that reducing practice variation would reduce costs. Nearly all respondents (234/249 [94%]) currently depend on practice guidelines. Clinicians rated differences in clinician style and experience as most influencing practice variation, and inaccessibility of guidelines as least influential. Time to apply standards, and patient decision aids, were rated most likely to help standardize practice. Nurse practitioners and physicians assistants (vs physicians) and less experienced (vs senior) clinicians rated more favorably several factors that might help to standardize practice. Differences by specialty and academic vs community practice were small.
Clinicians believe that practice variation should be reduced, but are less certain that this can be achieved. Accessibility of guidelines is not a significant barrier to practice standardization, whereas more time to apply standards is viewed as potentially helpful.
了解临床医生对医疗实践差异的看法以及如何减少这种差异。
2016年2月至4月，我们对一家学术医疗中心以及两家社区诊所中代表家庭医学、普通内科和心脏病学的获得委员会认证的医生（N = 178）、执业护士（N = 60）和医师助理（N = 12）进行了调查。基于互联网的问卷确定了临床医生对医疗实践差异、临床实践指南和成本的看法。
受访者一致认为医疗实践差异应予以减少（均值[标准差]4.5[1.1]；1 = 强烈反对，6 = 强烈赞同），但对于是否能够切实减少差异的认同度稍低（4.1[1.0]）。他们中度认同差异因情况不同而合理（3.9[1.2]）。他们强烈认为临床医生应有助于降低医疗成本（5.2[0.8]），但对于减少医疗实践差异能降低成本的认同度稍低（4.4[1.1]）。几乎所有受访者（234/249[94%]）目前都依赖临床实践指南。临床医生认为临床医生风格和经验的差异对医疗实践差异影响最大，而指南难以获取的影响最小。应用标准和患者决策辅助工具的时间被认为最有可能有助于规范医疗实践。执业护士和医师助理（与医生相比）以及经验不足的（与资深相比）临床医生对一些可能有助于规范医疗实践的因素评价更为积极。不同专业以及学术与社区医疗实践之间的差异较小。
临床医生认为医疗实践差异应予以减少，但不太确定能否实现这一点。指南的可获取性并非实践标准化的重大障碍，而更多的标准应用时间被认为可能会有帮助。
