Daniels M, Schroeder S A
Med Care. 1977 Jun;15(6):482-7. doi: 10.1097/00005650-197706000-00004.
Previous studies from this institution have shown extreme variation in laboratory and x-ray use among comparably trained physicians caring for similar patients. In addition, essentially no correlation (r = --.13) existed between a physician's lab use profile and subjective estimates of clinical competence. This study compares variations in lab use with both clinical productivity and outcome of care. Costs of lab tests of 149 long-term ambulatory hypertensive patients cared for by 13 faculty internists during one year were computed. Variation in mean annual lab costs per patient among the internists was great (range, $8-$161; standard deviation, $42). Outcomes of care were estimated using hypertension as an indicator condition. The physicians were scored according to percentage of hypertensive patients with systolic and diastolic pressures below specified levels. Correlation between lab use profiles and outcomes was negative (r = --.42) but not significant. Clinical productivity was estimated by two methods: adjusted panel size and subjective estimates of efficiency by the clinic administrator. Correlations between lab use behavior and each estimate of productivity were negligible (.13 and --.16 respectively). These data indicate that in this setting there is no positive association between a physician's frequency of lab use and either clinical productivity or outcomes of care.
该机构此前的研究表明，在为相似患者提供护理的同等训练水平的医生中，实验室检查和X光检查的使用存在极大差异。此外，医生的实验室检查使用情况与临床能力的主观评估之间基本不存在相关性（r = -0.13）。本研究将实验室检查使用的差异与临床工作效率和护理结果进行了比较。计算了13名内科住院医师在一年中为149名长期门诊高血压患者进行实验室检查的费用。内科医生之间每位患者年均实验室检查费用的差异很大（范围为8美元至161美元；标准差为42美元）。以高血压作为指标疾病来评估护理结果。根据收缩压和舒张压低于特定水平的高血压患者的百分比对医生进行评分。实验室检查使用情况与结果之间的相关性为负（r = -0.42），但不显著。通过两种方法评估临床工作效率：调整后的患者名单规模和诊所管理人员对效率的主观评估。实验室检查使用行为与每种工作效率评估之间的相关性可忽略不计（分别为0.13和 -0.16）。这些数据表明，在这种情况下，医生进行实验室检查的频率与临床工作效率或护理结果之间不存在正相关。
