Epstein A M, McNeil B J
Am J Med. 1986 May;80(5):865-70. doi: 10.1016/0002-9343(86)90630-3.
Understanding the reasons physicians order diagnostic tests may be useful in designing strategies to promote cost-effective practice and helpful in developing appropriate endpoints for evaluations of new diagnostic technologies. Testing by 27 private office physicians for 324 hypertensive patients was examined and the doctors were surveyed for their beliefs about appropriate levels of use for common tests, how they compared with other doctors in frequency of use, and their reasons for ordering tests. Beliefs about appropriate levels of testing were correlated with actual use (0.45 to 0.63, Pearson). Usage also correlated with beliefs about relative ordering patterns. Annual testing charges incurred by physicians who believed they ordered tests "more frequently" than average were higher than those who believed they ordered tests "less frequently" than average ($122 +/- $46 versus $51 +/- $15, p less than 0.05). Reasons for ordering tests were (in order of importance): establishing a baseline, assessing prognosis, reassuring patients, and helping with treatment decisions. These results suggest that "high usage" physicians may know who they are; and therefore strategies of feedback to modify behavior should be designed to do more than educate physicians about their own utilization. Second, evaluations of technology must consider more than contributions to immediate treatment decisions.
了解医生开具诊断测试的原因，可能有助于设计促进成本效益型医疗实践的策略，也有助于为评估新诊断技术制定合适的终点指标。研究了27位私人诊所医生对324名高血压患者进行的测试，并对医生进行了调查，了解他们对常见测试的适当使用水平的看法、他们与其他医生在使用频率上的比较情况以及他们开具测试的原因。对测试适当水平的看法与实际使用情况相关（Pearson相关系数为0.45至0.63）。使用情况也与对相对开具模式的看法相关。认为自己开具测试“比平均水平更频繁”的医生的年度测试费用高于那些认为自己开具测试“比平均水平更不频繁”的医生（122±46美元对51±15美元，p<0.05）。开具测试的原因依次为：建立基线、评估预后、安抚患者以及辅助治疗决策。这些结果表明，“高使用量”的医生可能知道自己的情况；因此，旨在改变行为的反馈策略不应仅仅是让医生了解自己的使用情况。其次，对技术的评估必须考虑的不仅仅是对即时治疗决策的贡献。
