Kahn K L, Kosecoff J, Chassin M R, Solomon D H, Brook R H
RAND Corporation, Santa Monica, California.
Ann Intern Med. 1988 Oct 15;109(8):664-70. doi: 10.7326/0003-4819-109-8-664.
To determine how appropriately physicians in 1981 did upper gastrointestinal endoscopy in a randomly selected, community-based sample of Medicare patients.
We developed a comprehensive and clinically detailed list of 1069 indications for upper gastrointestinal endoscopy. A national panel of nine clinicians rated the appropriateness of the indications. We categorized the indications as appropriate, inappropriate, or equivocal. We did a clinically detailed medical record review of a random sample of 1585 patients having upper gastrointestinal endoscopy to assess the appropriateness of using upper gastrointestinal endoscopy.
Patients were sampled from large geographic areas in three states. Two areas represented high use, and one area, low use.
Random sample of patients 65 years of age or older receiving diagnostic upper gastrointestinal endoscopy.
None; the study was retrospective.
Patient characteristics, histories, and clinical indications for upper gastrointestinal endoscopy were similar across low- and high-use areas. Overall, 72% of the endoscopies were done for appropriate indications, 11% for equivocal indications, and 17% for inappropriate indications. Upper gastrointestinal bleeding (26%), follow-up to an abnormal upper gastrointestinal series (21%), dysphagia (18%), and dyspepsia (15%) were the most frequent clinical reasons for doing endoscopy. Inpatient endoscopies were more often appropriate and less often inappropriate than outpatient endoscopies.
This analysis of practice patterns among study sites provides the clinical basis for understanding the use of upper gastrointestinal endoscopy. The finding of 17% inappropriate use may be cause for concern.
确定1981年医生对随机抽取的、以社区为基础的医疗保险患者进行上消化道内镜检查的恰当程度。
我们制定了一份包含1069条上消化道内镜检查适应证的全面且临床细节丰富的清单。由九名临床医生组成的全国性专家小组对这些适应证的恰当性进行了评估。我们将适应证分为恰当、不恰当或不明确三类。我们对1585例接受上消化道内镜检查的患者的随机样本进行了临床细节丰富的病历审查，以评估使用上消化道内镜检查的恰当性。
患者从三个州的大片地理区域中抽取。两个区域代表高使用量，一个区域代表低使用量。
年龄在65岁及以上接受诊断性上消化道内镜检查的患者随机样本。
无；该研究为回顾性研究。
低使用量和高使用量区域的患者特征、病史及上消化道内镜检查的临床适应证相似。总体而言，72%的内镜检查是出于恰当适应证进行的，11%是出于不明确适应证，17%是出于不恰当适应证。上消化道出血（26%）、对上消化道系列检查异常的随访（21%）、吞咽困难（18%）和消化不良（15%）是进行内镜检查最常见的临床原因。住院患者的内镜检查比门诊患者的内镜检查更常恰当且更少不恰当。
对研究地点实践模式的这项分析为理解上消化道内镜检查的使用提供了临床依据。17%的不恰当使用这一发现可能令人担忧。
