一种基于极简电子健康记录的干预措施，以减少常规实验室检查的使用。
A minimalist electronic health record-based intervention to reduce standing lab utilisation.
作者信息
Chin Kuo-Kai, Krishnamurthy Amrita, Zubair Talhah, Ramaswamy Tara, Hom Jason, Maggio Paul, Shieh Lisa
机构信息
Stanford University School of Medicine, Stanford, California, USA.
Department of Medicine, Stanford University, Stanford, California, USA.
出版信息
Postgrad Med J. 2021 Feb;97(1144):97-102. doi: 10.1136/postgradmedj-2019-136992. Epub 2020 Feb 12.
BACKGROUND
Repetitive laboratory testing in stable patients is low-value care. Electronic health record (EHR)-based interventions are easy to disseminate but can be restrictive.
OBJECTIVE
To evaluate the effect of a minimally restrictive EHR-based intervention on utilisation.
SETTING
One year before and after intervention at a 600-bed tertiary care hospital. 18 000 patients admitted to General Medicine, General Surgery and the Intensive Care Unit (ICU).
INTERVENTION
Providers were required to specify the number of times each test should occur instead of being able to order them indefinitely.
MEASUREMENTS
For eight tests, utilisation (number of labs performed per patient day) and number of associated orders were measured.
RESULTS
Utilisation decreased for some tests on all services. Notably, complete blood count with differential decreased 9% (p<0.001) on General Medicine and 21% (p<0.001) in the ICU.
CONCLUSIONS
Requiring providers to specify the number of occurrences of labs changes significantly reduces utilisation in some cases.
背景
对病情稳定的患者进行重复性实验室检查属于低价值医疗。基于电子健康记录（EHR）的干预措施易于推广，但可能具有局限性。
目的
评估基于EHR的最低限度限制性干预措施对医疗资源利用的影响。
设置
在一家拥有600张床位的三级护理医院进行干预前后各一年的研究。纳入普通内科、普通外科和重症监护病房（ICU）的18000名患者。
干预措施
要求医疗服务提供者明确每项检查应进行的次数，而非能够无限制地开具检查医嘱。
测量指标
针对八项检查，测量医疗资源利用情况（每位患者每天进行的实验室检查次数）以及相关医嘱数量。
结果
所有科室的部分检查的医疗资源利用情况有所下降。值得注意的是，普通内科的血常规加分类检查下降了9%（p<0.001），ICU下降了21%（p<0.001）。
结论
要求医疗服务提供者明确实验室检查的次数在某些情况下可显著降低医疗资源利用情况。
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