Liu Christina, Varady Nathan, Chruscielski Cassandra M, Zhang Dafang, Blazar Philip, Earp Brandon E
Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
J Hand Surg Glob Online. 2023 Sep 12;6(1):12-15. doi: 10.1016/j.jhsg.2023.07.020. eCollection 2024 Jan.
The primary aim of this study is to determine the rate of completion of clinic-based study orders. Secondarily, we attempt to determine factors associated with study incompletion.
This retrospective study included 591 clinic-based studies that were ordered for 510 patients at the time of clinical evaluation at a single medical center between April 8, 2018 and August 22, 2019. Inclusion criteria were studies ordered in a hand clinic for consecutive adult patients to be completed after the visit. Exclusion criteria included pediatric patients and routine radiographs obtained prior to the visit. Invasive studies were defined as studies with a significant procedural component, such as aspirations, injections and electromyography/nerve conduction (electrodiagnostic) studies (EDS). Blood tests and imaging were considered noninvasive. Patient demographics and study completion rates were collected through chart reviews. Univariate and bivariate analyses were performed, and <.05 was considered significant.
The overall clinic-based study completion rate was 94.2%, with the highest incompletion rates seen in invasive studies (8.3%, n = 34) compared to noninvasive studies (3.3%, n = 10). Within the invasive study category, EDS had the highest rate of incompletion (11.4%) and contributed to the majority of incompletions in the invasive cohort (20/24). The median time to study completion was 7 days (interquartile range [IQR] 2-21). Race, gender, English as primary language, marriage status, insurance type, and distance from facility were similar between completed and noncompleted studies.
Study completion rates were similar between all patients regardless of race, gender, and other social economic variables. Invasive studies, particularly EDS, had higher rates of incompletion and can be barriers to patients receiving additional care.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
本研究的主要目的是确定基于门诊的研究医嘱完成率。其次，我们试图确定与研究未完成相关的因素。
这项回顾性研究纳入了2018年4月8日至2019年8月22日期间在单一医疗中心对510例患者进行临床评估时开出的591项基于门诊的研究。纳入标准为在手诊科为成年连续患者开出的、就诊后需完成的研究。排除标准包括儿科患者以及就诊前获得的常规X光片。侵入性研究定义为具有显著操作部分的研究，如抽吸、注射和肌电图/神经传导（电诊断）研究（EDS）。血液检查和影像学检查被视为非侵入性检查。通过病历审查收集患者人口统计学数据和研究完成率。进行了单因素和双因素分析，P<0.05被认为具有统计学意义。
基于门诊的研究总体完成率为94.2%，侵入性研究的未完成率最高（8.3%，n = 34），而非侵入性研究的未完成率为3.3%（n = 10）。在侵入性研究类别中，EDS的未完成率最高（11.4%），且在侵入性队列的未完成情况中占多数（20/24）。研究完成的中位时间为7天（四分位间距[IQR] 2 - 21）。完成和未完成研究的患者在种族、性别、以英语为主要语言、婚姻状况、保险类型以及与医疗机构的距离方面相似。
无论种族、性别和其他社会经济变量如何，所有患者的研究完成率相似。侵入性研究，尤其是EDS，未完成率较高，可能会成为患者接受进一步治疗的障碍。
研究类型/证据水平：治疗性III级。
