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挪威一项旨在减少肩部关节镜检查不必要差异和过度使用的国家干预计划方案。

Protocol for a national intervention programme aimed to reduce unwarranted variation and overuse of shoulder arthroscopy in Norway.

作者信息

Tjomsland Ole, Bertilsson Helena Maria, Bjerkan Geir, Blomquist Per Jesper, Brox Jens Ivar, Bøe Berte Marie, Jøsendal Ola, Major Daniel, Panchakulasingam Kandiah, Stensland Eva, Strehle Michael, Valdimarsson Kristjan, Thoresen Christian

机构信息

South-Eastern Norway Regional Health Authority, Hamar, Norway

Faculty of Health Science, Department of Health, University of Stavanger, Stavanger, Norway.

出版信息

BMJ Open Qual. 2025 Feb 20;14(1):e003099. doi: 10.1136/bmjoq-2024-003099.

Abstract

Several advice-based approaches have aimed to reduce the overuse of procedures characterised as low-value healthcare services but have so far shown marginal impact on utilisation rates. Differences in utilisation rates tend to be associated with type of healthcare provider. Commercial providers have a tendency to have higher utilisations rates compared with non-profit providers. Norway has a publicly funded universal health coverage system where healthcare services are mainly provided by publicly owned hospitals in addition to a small number of non-profit hospitals and commercial hospitals reimbursed by the regional health authorities. According to previous experiences, unwarranted variation in utilisation rates can be associated with the type of healthcare provider. The aim of the present study is to evaluate the impact of tailoring the interventions on reducing overuse of low-value care based on an analysis of the clinical pathways and the various types of healthcare providers. The National Decision Forum in Norway has decided that acromion resection in patients with impingement symptoms and repair of non-traumatic cuff rupture should not be offered as standard treatment. The present protocol describes the planned intervention to reduce the overuse of these procedures.

摘要

几种基于建议的方法旨在减少被视为低价值医疗服务的程序的过度使用,但迄今为止对使用率的影响甚微。使用率的差异往往与医疗服务提供者的类型有关。与非营利性提供者相比,商业提供者的使用率往往更高。挪威有一个由公共资金资助的全民医保体系,除了少数非营利性医院和由地区卫生当局报销的商业医院外,医疗服务主要由公立医院提供。根据以往经验,使用率的不合理差异可能与医疗服务提供者的类型有关。本研究的目的是在分析临床路径和各类医疗服务提供者的基础上,评估针对性干预措施对减少低价值医疗过度使用的影响。挪威国家决策论坛已决定,不应将肩峰撞击症状患者的肩峰切除术和非创伤性肩袖破裂修复作为标准治疗方法。本方案描述了为减少这些手术的过度使用而计划采取的干预措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8462/11843012/9ae2c3bb1261/bmjoq-14-1-g001.jpg

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本文引用的文献

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Managing unwarranted variation in hospital care - findings from a regional audit in Norway.
Res Health Serv Reg. 2023 Nov 15;2(1):16. doi: 10.1007/s43999-023-00033-7.
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Milbank Q. 2021 Dec;99(4):1024-1058. doi: 10.1111/1468-0009.12531. Epub 2021 Aug 17.
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