Wachtel T, Moulton A W, Pezzullo J, Hamolsky M
Med Decis Making. 1986 Apr-Jun;6(2):101-9. doi: 10.1177/0272989X8600600208.
A group of 12 internists, members of a university-affiliated hospital, designed and implemented protocols for the general inpatient management of four medical problems (chest pain, stroke, pneumonia, and upper gastrointestinal hemorrhage). Hospital charges for the 63 cases were compared with charges generated by 64 controls who had been patients admitted to the same physicians with the same diagnoses during the same period of the preceding year, before the project was begun. A group of nonparticipating internists was similarly evaluated during the two time periods to control for changes in practice patterns extraneous to the intervention. Adjustment was made for inflation (6%) and differences in case mix. The program resulted in a 15% reduction in total average charge generated by the cases. Sizeable reductions were achieved in utilization of EKGs (34.8%), x-rays (15.4%), laboratory testing (20.4%), and drugs (11.4%). Given the prevailing attitude that health care costs are too high and that many services are unnecessary, the benefit of altering physician behavior by using standards established by them for themselves could be substantial, especially with the threat of more restrictive and less sympathetic modes of controlling costs.
一所大学附属医院的12名内科医生设计并实施了针对四种医疗问题（胸痛、中风、肺炎和上消化道出血）的普通住院患者管理方案。将63例患者的医院收费与64名对照患者的收费进行了比较，这些对照患者是在项目开始前的上一年同期由同一些医生收治的患有相同诊断的患者。在两个时间段内，对一组未参与的内科医生进行了类似的评估，以控制与干预无关的医疗模式变化。对通货膨胀（6%）和病例组合差异进行了调整。该方案使病例产生的总平均费用降低了15%。心电图检查（34.8%）、X光检查（15.4%）、实验室检查（20.4%）和药品（11.4%）的使用量大幅减少。鉴于普遍认为医疗保健成本过高且许多服务不必要的态度，通过使用医生自己为自己制定的标准来改变医生行为的益处可能很大，特别是在面临更严格且缺乏同情心的成本控制模式的威胁时。
