健康系统因素与临床教学单位常规实验室检查利用的关联：队列分析。

Association Between Health System Factors and Utilization of Routine Laboratory Tests in Clinical Teaching Units: a Cohort Analysis.

机构信息

Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada.

Department of Community Health Sciences, Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.

出版信息

J Gen Intern Med. 2022 May;37(6):1444-1449. doi: 10.1007/s11606-021-07063-2. Epub 2021 Aug 5.

DOI:10.1007/s11606-021-07063-2

PMID:34355347

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9085997/

Abstract

BACKGROUND

Few studies have looked at health system factors associated with laboratory test use.

OBJECTIVE

To determine the association between health system factors and routine laboratory test use in medical inpatients.

DESIGN

We conducted a retrospective cohort study on adult patients admitted to clinical teaching units over a 3-year period (January 2015 to December 2017) at three tertiary care hospitals in Calgary, Alberta.

PARTICIPANTS

Patients were assigned to a Case Mix Group+ (CMG+) category based on their clinical characteristics, and patients in the top 10 CMG+ groups were included in the cohort.

EXPOSURES

The examined health system factors were (1) number of primary attending physicians seen by a patient, (2) number of attending medical teams seen by a patient, (3) structure of the medical team, and (4) day of the week.

MAIN MEASURES

The primary outcome was the total number of routine laboratory tests ordered on a patient during their admission. Statistical models were adjusted for age, sex, length of stay, Charlson comorbidity index, and CMG+ group.

RESULTS

The final cohort consisting of 36,667 patient-days in hospital (mean (SD) age 62.5 (18.4) years) represented 5071 unique hospitalizations and 4324 unique patients. Routine laboratory test use was increased when patients saw multiple attending physicians; with an adjusted incidence rate ratio (IRR) of 1.46 (95% CI, 1.37-1.55) for two attending physicians, and 2.50 (95% CI, 2.23-2.79) for three or more attending physicians compared to a single attending physician. The number of routine laboratory tests was slightly lower on weekends (IRR 0.98, 95% CI, 0.96-0.99) and on teams without a senior resident as part of their team structure (IRR 0.89, 95% CI 0.830.96).

CONCLUSIONS

The associations observed in this study suggest that breaks in continuity of care, including increased frequency in patient transfer of care, may impact the utilization of routine laboratory tests.

摘要

背景

很少有研究关注与实验室检测使用相关的卫生系统因素。

目的

确定卫生系统因素与住院患者常规实验室检测使用之间的关系。

设计

我们对 3 家卡尔加里三级保健医院的临床教学病房在 3 年期间（2015 年 1 月至 2017 年 12 月）内的成年住院患者进行了回顾性队列研究。

参与者

根据患者的临床特征，将患者分配到病例组合组+(CMG+)类别，并且将前 10 个 CMG+组的患者纳入队列。

暴露因素

所检查的卫生系统因素包括（1）患者接受的主治医生数量，（2）患者接受的主治医疗团队数量，（3）医疗团队结构，和（4）就诊日。

主要措施

主要结局是患者住院期间的常规实验室检测总数。统计模型调整了年龄、性别、住院时间、Charlson 合并症指数和 CMG+组。

结果

最终队列由 36667 个患者日组成（平均（SD）年龄 62.5（18.4）岁），代表 5071 例次住院和 4324 例次患者。当患者看到多名主治医生时，常规实验室检测的使用增加；与仅一名主治医生相比，有两名主治医生的调整发病率比（IRR）为 1.46（95%CI，1.37-1.55），有三名或更多主治医生的 IRR 为 2.50（95%CI，2.23-2.79）。周末的常规实验室检测数量略低（IRR 0.98，95%CI，0.96-0.99），且团队结构中没有高级住院医师的团队的常规实验室检测数量也较低（IRR 0.89，95%CI 0.83-0.96）。