Valenstein P, Leiken A, Lehmann C
Department of Pathology, State University of New York, Stony Brook.
Arch Pathol Lab Med. 1988 Mar;112(3):238-41.
In modern teaching hospitals, patients typically receive direct care from a succession of different physicians, each of whom may order diagnostic tests on the same patient. We examined the association of test-ordering by multiple physicians with unnecessary duplication of 20-test chemistry profiles in 198 consecutively admitted patients. In a multivariate regression model, the number of duplicate chemistry profiles ordered for a patient was significantly correlated with the number of physicians ordering profiles after controlling for the overall intensity of profile testing. In a case-control analysis comparing duplicate with nonduplicate profiles, redundant tests were significantly more likely to have been ordered by a new physician who had not ordered a patient's previous profile than by the same physician who had ordered the previous chemistry panel. We conclude that test ordering by multiple physicians, the prevalent pattern in almost all teaching hospitals, predisposes to unnecessary laboratory examinations.
在现代教学医院中，患者通常会先后接受不同医生的直接诊疗，每位医生都可能为同一患者开具诊断检查。我们研究了多名医生开具检查与198例连续入院患者20项化学指标检测不必要重复之间的关联。在多变量回归模型中，在控制了化学指标检测的总体强度后，为患者开具重复化学指标检测的数量与开具检测的医生数量显著相关。在一项将重复检测与非重复检测的化学指标进行对比的病例对照分析中，与开具过患者上次化学指标检测的同一位医生相比，新医生开具冗余检测的可能性显著更高，而这些新医生此前并未开具过该患者的化学指标检测。我们得出结论，多名医生开具检查这一几乎所有教学医院都普遍存在的模式，易导致不必要的实验室检查。
