Rheumatology Division, Hospital General de Villalba, Madrid, Spain.
Preventive Medicine, Hospital General de Villalba, Madrid, Spain.
Rheumatology (Oxford). 2021 Apr 6;60(4):1832-1838. doi: 10.1093/rheumatology/keaa678.
To evaluate the impact of the routine use of musculoskeletal ultrasound (MSUS) in rheumatology clinics by comparing one clinic with on-site MSUS (REU 1) and four clinics without this resource, which need to refer patients for the MSUS exams (REU 2-5).
The electronic medical records of all new patients at five rheumatology clinics during a 12-month period were reviewed. The impact of MSUS was analysed by comparing the percentage of direct discharges of patients from the different clinics, as an outcome of effectiveness, and the number and cost of radiology referrals for imaging exams (MSUS and MRI), as an outcome of cost-saving.
The medical records of 4923 patients were included in the study, distributed as follows: REU 1, 1464 (29.7%); REU 2, 1042 (21.2%); REU 3, 1089 (22.1%); REU 4, 579 (11.8%); and REU 5, 749 (15.2%). There were more direct discharges from REU 1 (34.4%) than from REU 2-5 (15.6%) (P<0.001). REU 1 made radiological referrals for X-rays, MRIs or MSUS exams in 773 (52.8%) patients, compared with 2626 (75.9%) patients in REU 2-5 (P<0.001). An estimation of costs for the clinical assessment of 1000 new patients revealed a cost-saving in REU 1 of €21 413 in MSUS and of €877 in MRI exams.
The implementation of on-site MSUS in a new-patient rheumatology clinic is cost-effective, facilitating the direct discharge of patients and reducing the number and cost of radiological referrals for imaging exams.
通过比较一个设有肌骨超声（MSUS）的诊所（REU 1）和需要为 MSUS 检查转诊患者的四个诊所（REU 2-5），评估在风湿病诊所常规使用 MSUS 的影响。
在 12 个月内，对五个风湿病诊所的所有新患者的电子病历进行了回顾。通过比较不同诊所的患者直接出院率（作为有效性的结果）以及放射科转诊进行影像学检查（MSUS 和 MRI）的数量和费用（作为节省成本的结果），分析 MSUS 的影响。
本研究共纳入 4923 例患者的病历，分布如下：REU 1，1464 例（29.7%）；REU 2，1042 例（21.2%）；REU 3，1089 例（22.1%）；REU 4，579 例（11.8%）；REU 5，749 例（15.2%）。REU 1 的直接出院率（34.4%）高于 REU 2-5（15.6%）（P<0.001）。REU 1 为 773 例（52.8%）患者进行了 X 线、MRI 或 MSUS 检查的放射学转诊，而 REU 2-5 为 2626 例（75.9%）患者进行了放射学转诊（P<0.001）。对 1000 例新患者的临床评估费用进行估算，发现 REU 1 在 MSUS 和 MRI 检查方面节省了 21413 欧元的费用。
在新患者的风湿病诊所实施现场 MSUS 具有成本效益，可促进患者的直接出院，并减少影像学检查的放射科转诊数量和费用。
