Soumerai S B, Salem-Schatz S, Avorn J, Casteris C S, Ross-Degnan D, Popovsky M A
Department of Social Medicine, Harvard Medical School, Boston, MA 02115.
JAMA. 1993 Aug 25;270(8):961-6.
To determine whether brief, face-to-face educational outreach visits can improve the appropriateness of blood product utilization.
Randomized, controlled multicenter trial with 6-month follow-up.
Surgical and medical services of two pairs of matched community and teaching hospitals in Massachusetts.
One hundred one transfusing staff surgeons and attending medical physicians.
A professionally based transfusion specialist presented one surgical- or medical-service-wide lecture emphasizing appropriate indications, risks, and benefits of red blood cell transfusions; brief, graphic, printed educational guidelines; and one 30-minute visit with each transfusing physician. No data feedback was provided. Educational messages emphasized the lack of utility of the traditional threshold for red blood cell transfusions (hematocrit, 30%) and transfusion risks (eg, viral hepatitis).
Proportion of red blood cell transfusions classified as compliant or noncompliant with blood transfusion guidelines, or indeterminate 6 months before and 6 months after an experimental educational intervention.
Based on analyses of 1449 medical record audits of red blood cell transfusions that occurred 6 months before and 6 months after the educational intervention, the average proportion of transfusions not in compliance with criteria declined from 0.40 to 0.24 among study surgeons (-40%) compared with an increase from 0.40 to 0.44 (+9%) among control surgeons (P = .006). These effects were consistent across procedure type and specialty. On average, study surgeons in the postintervention period performed transfusions when hematocrits were 2.0 percentage points lower than before the intervention (28.3% preintervention vs 26.3% postintervention), and lower than in the control group (28.3% preintervention and postintervention; P = .04). Likely savings in blood use for surgical services probably exceeded program costs, even without considering reduced risks of infection. No effects were observed among transfusions occurring in medical services, possibly because of substantially lower transfusion rates and lower pretransfusion hematocrits.
Brief, focused educational outreach visits by transfusion specialists can substantially improve the appropriateness and cost-effectiveness of blood product use in surgery. More data are needed regarding the durability of changes in practice patterns and the health and economic benefits of such interventions.
确定简短的面对面教育外展访问能否提高血液制品使用的合理性。
随机对照多中心试验，随访6个月。
马萨诸塞州两对匹配的社区医院和教学医院的外科及内科服务科室。
101名进行输血操作的外科医生和内科主治医生。
一位专业输血专家开展一次面向整个外科或内科服务科室的讲座，强调红细胞输血的适当指征、风险和益处；发放简短、图文并茂的印刷版教育指南，并与每位进行输血操作的医生进行一次30分钟的访问。未提供数据反馈。教育信息强调了传统红细胞输血阈值（血细胞比容，30%）的无用性及输血风险（如病毒性肝炎）。
在实验性教育干预前后6个月，将红细胞输血分类为符合或不符合输血指南，或不确定的比例。
基于对教育干预前后6个月内发生的1449例红细胞输血病历审核分析，研究组外科医生中不符合标准的输血平均比例从0.40降至0.24（-40%），而对照组外科医生中该比例从0.40升至0.44（+9%）（P = 0.006）。这些影响在手术类型和专业方面是一致的。平均而言，干预后研究组外科医生进行输血时的血细胞比容比干预前低2.0个百分点（干预前为28.3%，干预后为26.3%），且低于对照组（干预前后均为28.3%；P = 0.04）。即使不考虑感染风险降低，外科服务中血液使用量的可能节省可能超过项目成本。在内科服务中进行的输血未观察到效果，可能是因为输血率和输血前血细胞比容大幅降低。
输血专家进行的简短、有针对性的教育外展访问可显著提高手术中血液制品使用的合理性和成本效益。关于实践模式变化的持久性以及此类干预措施的健康和经济效益，还需要更多数据。
