Axt-Adam P, van der Wouden J C, van der Does E
Department of General Practice, Erasmus University Medical School, Rotterdam, The Netherlands.
Med Care. 1993 Sep;31(9):784-94. doi: 10.1097/00005650-199309000-00003.
There are various reasons why physicians order laboratory tests. Earlier studies have shown that in many cases test-ordering behavior lacks efficiency, resulting in excessive laboratory utilization. Throughout the years various attempts have been made to improve this situation. This review, based on the literature of the past 20 years, gives a survey of interventions and their effectiveness. Various types of education are discussed: general, cost-control oriented and education by means of guidelines, protocols, decision support systems, and feedback (on test ordering or cost). The discussion addresses the quality and apparent restrictions of the studies, and provides possible causes of the widely varying, but mostly low success rates. The long-term effectiveness of interventions aiming at better laboratory ordering is rather unfavorable.
医生开具实验室检查单有多种原因。早期研究表明，在许多情况下，开单行为缺乏效率，导致实验室检查过度使用。多年来，人们进行了各种尝试来改善这种情况。本综述基于过去20年的文献，对干预措施及其效果进行了调查。讨论了各种类型的教育：一般教育、以成本控制为导向的教育以及通过指南、方案、决策支持系统和反馈（关于检查开单或成本）进行的教育。讨论涉及研究的质量和明显限制，并提供了成功率差异很大但大多较低的可能原因。旨在改善实验室检查开单的干预措施的长期效果相当不理想。
