Golden W E, Pappas A A, Lavender R C
Arch Intern Med. 1987 Jun;147(6):1045-8.
Previous studies have examined methods of reducing laboratory use, without great success. We studied the effects of the financial unbundling of clinical biochemistry determinations in a university outpatient clinic. After eliminating the charge structure that promoted panel use, the ordering of chemistry 19 panels fell dramatically, accompanied by an increase in orders for electrolyte and chemistry 6 panels. The total number of biochemical assay determinations fell by one third after this administrative intervention. Only orders for potassium and creatinine measurements remained relatively unchanged and eventually increased. The ordering of five analytes of the chemistry 19 profile was reduced by at least 50%. Reassessment of the intervention six months later demonstrated the sustained decline in laboratory use. We conclude that physicians are attuned to price inefficiencies in basic laboratory testing and can alter their ordering behavior accordingly. Facilities can change patterns of use by altering charge structures alone. The decline in laboratory testing also indicates that physicians receive unnecessary clinical data when they order biochemical profiles. Financially bundled chemistry profiles could be replaced by physiologically based test groupings.
以往的研究探讨了减少实验室检查使用量的方法，但成效不大。我们研究了大学门诊临床生化检测费用拆分的影响。取消了鼓励使用套餐检测的收费结构后，19项化学检测套餐的开单量大幅下降，同时电解质和6项化学检测套餐的订单量有所增加。此次行政干预后，生化检测的总次数下降了三分之一。只有钾和肌酐检测的订单量相对保持不变，最终还有所增加。19项化学检测项目中的5种分析物的开单量减少了至少50%。6个月后对该干预措施的重新评估显示，实验室检查使用量持续下降。我们得出结论，医生会关注基础实验室检测中的价格低效问题，并能相应地改变他们的开单行为。医疗机构仅通过改变收费结构就能改变使用模式。实验室检测的减少也表明，医生在开生化检测套餐时会收到不必要的临床数据。基于财务捆绑的化学检测套餐可以被基于生理的检测分组所取代。
