Sage W M, Kessler R, Sommers L S, Silverman J F
Division of Diagnostic Radiology (Radiology), Stanford University School of Medicine, California.
J Urol. 1988 Aug;140(2):311-5. doi: 10.1016/s0022-5347(17)41590-4.
Cost containment need not be imposed on physicians by government, insurance companies and hospital administrators. Decreases in hospital cost can be achieved voluntarily by physicians without sacrificing quality of care, especially for common procedures with relatively homogeneous patient populations, such as transurethral prostatectomy. Variations in existing practice were identified and shared, and optimal scientific practice was discussed at 5 meetings of the division of urology during a 16-month period. Strict guidelines were not developed; surgeons were encouraged to apply cost-related knowledge individually. Resource use was measured before, during and after the intervention. A total of 356 transurethral prostatectomies was studied. There were significant decreases in preoperative and postoperative length of stay, specific ordering practices and total hospital charges. University faculty differed from community urologists and individual surgeons varied considerably. Suggestions for scientific cost management in prostatectomy are presented.
成本控制无需由政府、保险公司和医院管理人员强加给医生。医生可以在不牺牲医疗质量的情况下自愿降低医院成本，特别是对于患者群体相对同质化的常见手术，如经尿道前列腺切除术。在16个月的时间里，泌尿外科在5次会议上确定并分享了现有实践中的差异，并讨论了最佳科学实践。没有制定严格的指导方针；鼓励外科医生各自应用与成本相关的知识。在干预前、干预期间和干预后对资源使用情况进行了测量。共研究了356例经尿道前列腺切除术。术前和术后住院时间、具体医嘱做法和医院总费用均有显著下降。大学教员与社区泌尿科医生不同，而且个体外科医生之间也有很大差异。本文提出了前列腺切除术科学成本管理的建议。
