Dillon E C, Sergott R C, Savino P J, Bosley T M
Wills Eye Hospital, Neuro-Ophthalmology Service, Philadelphia, PA 19107.
Ophthalmology. 1994 Sep;101(9):1627-30. doi: 10.1016/s0161-6420(94)31127-4.
To determine whether the "gatekeeper physician system" for evaluating neuro-ophthalmologic problems is cost effective.
The authors retrospectively reviewed the records of 588 patients referred for neuro-ophthalmologic evaluation between July and December 1989 to determine the frequency and cost of unnecessary diagnostic testing ordered by "gatekeeper physicians." Pre-referral diagnostic testing costs were compared with the cost of neurophthalmologic consultation for four common problems: (1) optic neuropathy; (2) diplopia; (3) ptosis; and (4) proptosis.
Between 16% and 26% of patients in the first three diagnostic categories were subjected to overtesting, resulting in $57,900 of excessive costs, a 724% overcharge. Although the evaluation of proptosis was performed correctly, the quality of 10 of the 18 neuro-imaging procedures was substandard.
The gatekeeper system managed by primary care physicians for these four neuro-ophthalmologic problems not only did not conserve healthcare dollars but also had a negative impact on cost control. For neuro-ophthalmologic disorders, prompt subspecialty evaluation and examination appear to be a cost-effective strategy.
确定用于评估神经眼科问题的“守门医生系统”是否具有成本效益。
作者回顾性分析了1989年7月至12月间被转诊进行神经眼科评估的588例患者的记录，以确定“守门医生”所开具的不必要诊断检查的频率和成本。将转诊前的诊断检查成本与针对四种常见问题的神经眼科会诊成本进行比较：（1）视神经病变；（2）复视；（3）上睑下垂；（4）眼球突出。
在前三个诊断类别中，16%至26%的患者接受了过度检查，导致成本超支57,900美元，多收费用达724%。尽管对眼球突出的评估是正确的，但18项神经影像学检查中有10项质量不合格。
由初级保健医生管理的这四种神经眼科问题的守门系统不仅没有节省医疗费用，而且对成本控制产生了负面影响。对于神经眼科疾病，及时进行专科评估和检查似乎是一种具有成本效益的策略。
