Khorasani R, Silverman S G, Meyer J E, Gibson M, Weissman B N, Seltzer S E
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
AJR Am J Roentgenol. 1994 Aug;163(2):457-9. doi: 10.2214/ajr.163.2.8037049.
The steady increase in costs related to testing has been a major factor in the overall growth of health care expenses. Concern is substantial about the excessive number of tests ordered by physicians without measurable improvement in patients' outcomes. This is of particular concern in teaching hospitals, because in addition to the direct impact on national health care expenditures, these are the institutions in which young physicians train and formulate test-ordering practices. Proper selection of imaging tests is a complex process that requires detailed information about the patient; specific questions to be answered; and knowledge of the characteristics of the test, including sensitivity, specificity, risks, and cost. To date, no systematic method exists for combining the expertise of the radiologist with that of the referring physician before the tests are selected. Therefore, we designed a new clinical service within the radiology department that allows formal, on-the-ward consultation to assist internal medicine housestaff in the selection of radiologic tests. The goal of this study was to assess the feasibility of this formal radiology consultation service and to determine how often its imaging recommendations were implemented for patients with complicated medical conditions.
与检查相关的成本持续增加，这是医疗保健费用总体增长的一个主要因素。人们对医生开具过多检查单却未给患者带来可衡量的疗效改善这一现象深感担忧。这在教学医院尤为令人关注，因为除了对国家医疗保健支出有直接影响外，这些医院还是年轻医生培训和形成检查开单习惯的机构。正确选择影像检查是一个复杂的过程，需要有关患者的详细信息、有待回答的具体问题以及对检查特征的了解，包括敏感性、特异性、风险和成本。迄今为止，在选择检查之前，尚无将放射科医生的专业知识与转诊医生的专业知识相结合的系统方法。因此，我们在放射科设计了一项新的临床服务，提供正式的病房会诊，以协助内科住院医师选择放射检查。本研究的目的是评估这种正式放射科会诊服务的可行性，并确定针对患有复杂病症的患者，其影像检查建议的实施频率。
