Traverso L W
Section of General Surgery, Virginia Mason Medical Center, Seattle, WA 98111, USA.
Surg Clin North Am. 1996 Feb;76(1):129-38. doi: 10.1016/s0039-6109(05)70427-8.
The key to evaluating a procedure in regard to a true advance versus a gimmick is to determine its value. This can be done only by physicians cognizant of a disease process. The value is determined by assessing a procedure's utilization, outcomes, and costs. Utilization allows early treatment and avoids neglected disease. Therefore, the appropriateness of the utilization can be determined only by an outcome study. An outcome study is another term for quality assessment. Outcomes deal with morbidity, mortality, and also the long- and short-term effects of the procedure on the disease. Overall, an increase of quality in a global perspective decreases the costs of the procedure to the health care community. Costs must remain secondary to outcomes. An attempt to decrease costs directly is a maneuver that, when applied by nonmedical individuals, will most likely decrease quality. When the quality can be maintained (as assessed only by a practitioner), then a decrease in global costs will increase value. The concept of increasing value by increasing quality without an attempt to decrease costs is a very important principle that the health care system must learn in our ever-challenging medical environment. Is a new procedure a gimmick or a true advance? The decision is made jointly by the stakeholders in our health care system--the patient, provider, payer, employer, and industry. If the procedure does not receive negative votes, then its adoption is almost assured. Comparing two procedures through these perspectives ultimately allows us to determine the potential for new procedures. A procedure not adopted through this method could be called a gimmick.
评估一种医疗程序是真正的进步还是噱头的关键在于确定其价值。这只能由了解疾病过程的医生来完成。价值是通过评估一种医疗程序的利用率、结果和成本来确定的。利用率能实现早期治疗并避免疾病被忽视。因此，只有通过结果研究才能确定利用率的合理性。结果研究是质量评估的另一种说法。结果涉及发病率、死亡率，以及该医疗程序对疾病的长期和短期影响。总体而言，从全球角度提高质量会降低医疗保健界实施该医疗程序的成本。成本必须居于结果之后。直接降低成本的尝试，如果由非医疗人员来操作，很可能会降低质量。当质量能够得到维持（仅由从业者评估）时，那么全球成本的降低将增加价值。在不试图降低成本的情况下通过提高质量来增加价值的理念，是医疗保健系统在我们这个充满挑战的医疗环境中必须学习的一个非常重要的原则。一种新的医疗程序是噱头还是真正的进步？这一决定由我们医疗保健系统中的利益相关者——患者、提供者、付款方、雇主和行业共同做出。如果该医疗程序没有得到反对票，那么它几乎肯定会被采用。通过这些视角比较两种医疗程序最终能让我们确定新医疗程序的潜力。未通过这种方法被采用的医疗程序可被称为噱头。
