Epstein A M, McNeil B J
Department of Medicine (Division of General Medicine), Brigham and Women's Hospital, Boston, MA.
Med Care. 1988 Jan;26(1):1-8. doi: 10.1097/00005650-198801000-00001.
To determine temporal changes in the outpatient use of diagnostic tests, the authors studied ambulatory testing for 208 patients diagnosed with uncomplicated hypertension, cared for by 15 private office internists in 1971 through 1980. Patients diagnosed and treated earlier in the decade tended to have significantly higher blood pressure. After adjustment for blood pressure, use of diagnostic tests in terms of total charges for testing per patient per year peaked between 1973-74 and thereafter remained fairly stable at a level slightly lower than that in 1973-74. Considering the decade as a whole, use of tests was generally greater for patients with higher blood pressure readings (P less than 0.05). These findings suggest that use of tests for hypertensive patients in outpatient settings is related to severity of disease. Although treatment of new patient groups may be one factor increasing medical costs, the use of tests per se may have stabilized for diseases in which the diagnostic technologies have remained stable.
为了确定门诊诊断检查使用情况的时间变化，作者研究了1971年至1980年期间由15名私人诊所内科医生照料的208例被诊断为单纯性高血压患者的门诊检查情况。在该十年中较早被诊断和治疗的患者往往血压显著更高。在对血压进行调整后，以每年每位患者的检查总费用计算的诊断检查使用量在1973 - 1974年达到峰值，此后保持在略低于1973 - 1974年的水平且相当稳定。从整个十年来看，血压读数较高的患者的检查使用量总体上更大（P小于0.05）。这些发现表明，门诊环境中高血压患者的检查使用与疾病严重程度相关。尽管治疗新患者群体可能是增加医疗成本的一个因素，但对于诊断技术保持稳定的疾病，检查本身的使用可能已经趋于稳定。
