Katz S J, McMahon L F, Manning W G
Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0376, USA.
Med Care. 1996 Feb;34(2):117-25. doi: 10.1097/00005650-199602000-00004.
Although Americans pay much more for a day in the hospital than Canadians, we know little about whether inpatient physician practice patterns might explain some of this difference. The authors compared the utilization of all diagnostic imaging (plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) scanning, ultrasound, nuclear medicine and vascular studies) and selected laboratory tests (hematology, basic biochemistry, and advanced biochemistry) for all patients discharged with selected medical and surgical diagnoses in 1990 and 1991 from four university hospitals and four community hospitals in Canada (n = 6,491) and the United States (n = 7,980). Overall, US medical patients received 22% more diagnostic tests than their Canadian counterparts (544.2 relative value units [RVUs] vs. 446.5 RVUs in Canada, P < 0.001), which was mainly the result of higher radiology use. Although mean radiology use was 40% higher in the United States (370.0 vs. 264.5 RVUs in Canada, P < 0.05), there was little difference in the use of laboratory tests between countries (174.2 vs. 182.4 RVUs in Canada, P = 0.3). Within radiology, only CT and MRI use differed significantly between countries (US patients received 119% more tests than Canadians). These findings were consistent after adjustments for age, gender, diagnosis-related group, and university status. Differences in test use between countries were mainly the result of more testing among the US elderly than counterparts in Canada. Among surgical patients, there was little difference between countries for radiology (76.3 vs. 67.3 RVUs in Canada, P < 0.05) and laboratory (83.6 vs. 91.4 RVUs in Canada, P < 0.05). Comparable inpatients admitted to US hospitals received more diagnostic tests than their Canadian counterparts even in hospitals with similar availability of technology. Differences between countries were larger for high-cost tests than for lower-cost tests. Much of the difference in test use is explained by more intensive use for the elderly in the United States.
尽管美国人在医院一天的花费比加拿大人高得多，但我们对住院医生的诊疗模式是否能解释这种差异的一部分知之甚少。作者比较了1990年和1991年从加拿大（n = 6491）和美国（n = 7980）的四家大学医院和四家社区医院出院的所有患有特定内科和外科诊断疾病的患者对所有诊断成像（普通X光、计算机断层扫描（CT）和磁共振成像（MRI）扫描、超声、核医学和血管造影）以及选定实验室检查（血液学、基础生物化学和高级生物化学）的使用情况。总体而言，美国内科患者接受的诊断检查比加拿大同行多22%（544.2相对价值单位[RVUs]，而加拿大为446.5 RVUs，P < 0.001），这主要是放射学检查使用更多的结果。尽管美国的平均放射学检查使用量比加拿大高40%（370.0 vs. 264.5 RVUs，P < 0.05），但两国之间实验室检查的使用差异不大（加拿大为174.2 vs. 182.4 RVUs，P = 0.3）。在放射学检查中，只有CT和MRI的使用在两国之间存在显著差异（美国患者接受的检查比加拿大多119%）。在对年龄、性别、诊断相关分组和大学地位进行调整后，这些发现仍然一致。两国之间检查使用的差异主要是由于美国老年人比加拿大同龄人接受了更多检查。在外科患者中，两国在放射学检查（加拿大为76.3 vs. 67.3 RVUs，P < 0.05）和实验室检查（加拿大为83.6 vs. 91.4 RVUs，P < 0.
