Kherad Omar, Bottequin Ezra, Steiner Dorsaf, Alibert Axelle, Eurin Rodolphe, Bothorel Hugo
Internal Medicine Division, Hôpital de la Tour and University of Geneva, 1217 Geneva, Switzerland.
Business Intelligence Unit, Hôpital de la Tour, 1217 Geneva, Switzerland.
J Clin Med. 2022 Apr 26;11(9):2435. doi: 10.3390/jcm11092435.
The dissemination of recommendations on low-value care alone may not lead to physicians' behavioral changes. The aim of this study was to evaluate whether a multifaceted behavioral intervention among internal medicine residents could reduce low-value care in hospitalized patients.
A pre-post quality improvement intervention was conducted at the Internal Medicine Division of La Tour hospital (Geneva, Switzerland) from May 2020 to October 2021. The intervention period (3 months) consisted of a multifaceted informational intervention with audits and educative feedback about low-value care. The pre- and post-intervention periods including the same six calendar months were compared in terms of number of blood samples per patient day, prescription rates of benzodiazepines (BZDs) and proton pump inhibitors (PPIs), as well as safety indicators including potentially avoidable readmissions, premature deaths and complications.
A total of 3400 patients were included in this study; 1095 (32.2%) and 1155 (34.0%) were, respectively, hospitalized during the pre- and post-intervention periods. Patient characteristics were comparable between the two periods. Only the number of blood tests per patient day and the BZD prescription rate at discharge were significantly reduced in the post-intervention phase (pre: 0.54 ± 0.43 vs. post: 0.49 ± 0.60, ≤ 0.001; pre: 4.2% vs. post: 1.7%, = 0.003, respectively). PPI prescription rates remained comparable. Safety indicators analyses revealed no significant differences between the two periods of interest.
Our results demonstrate a modest but statistically significant effect of a multifaceted educative intervention in reducing the number of blood tests and the BZD prescription rate at discharge in hospitalized patients. Limiting low-value services is very challenging and additional long-term interventions are necessary for wider implementation.
仅传播关于低价值医疗的建议可能不会导致医生行为的改变。本研究的目的是评估在内科住院医师中开展多方面行为干预是否能减少住院患者的低价值医疗。
2020年5月至2021年10月在瑞士日内瓦拉图尔医院内科进行了一项前后对照的质量改进干预。干预期（3个月）包括多方面的信息干预，其中有关于低价值医疗的审核和教育反馈。在每位患者每天的血样数量、苯二氮䓬类药物（BZD）和质子泵抑制剂（PPI）的处方率以及安全指标（包括潜在可避免的再入院、过早死亡和并发症）方面，对包括相同六个日历月的干预前和干预期进行了比较。
本研究共纳入3400例患者；干预前和干预期分别有1095例（32.2%）和1155例（34.0%）住院。两个时期的患者特征具有可比性。干预后阶段，仅每位患者每天的血检数量和出院时的BZD处方率显著降低（干预前：0.54±0.43 vs.干预后：0.49±0.60，P≤0.001；干预前：4.2% vs.干预后：1.7%，P = 0.003）。PPI处方率保持可比。安全指标分析显示两个感兴趣时期之间无显著差异。
我们的结果表明，多方面教育干预在减少住院患者血检数量和出院时BZD处方率方面有适度但具有统计学意义的效果。限制低价值服务非常具有挑战性，需要额外的长期干预措施以实现更广泛的实施。
