Shugars D A, Bader J D
Department of Operative Dentistry, University of North Carolina, School of Dentistry, NC 27599-7450, USA.
J Public Health Dent. 1996 Summer;56(4):219-22. doi: 10.1111/j.1752-7325.1996.tb02439.x.
This study sought to determine the effects of variation in both dentists' decisions to treat and choice of treatment on the costs of care.
Each of 37 patients was examined individually by several practicing dentists (between 3-22, mean = 6.2). For each dentist's recommended treatment for each patient, the total cost of restorative treatment was calculated first using the least expensive treatment possible for each tooth indicated as needing treatment, and second using the costs of specific treatment selected by each dentist
Considerable variation was found among dentists in each patients cost of treatment using both methods. The mean of the median cost per patient of the specific treatment selected was three times larger than the cost per patient of basic treatment. Few dentists were found to consistently recommend higher or lower cost treatment plans.
These findings suggest that inconsistencies in both dentists' decisions to intervene and dentists' selection of treatment can have a profound effect on cost. Further, focusing utilization review on "outlier dentists" is likely to be much less productive in containing costs and improving quality than comprehensive attempts to improve consistency across the profession.
本研究旨在确定牙医治疗决策的差异以及治疗选择对护理成本的影响。
37名患者分别由几名执业牙医（3至22名，平均6.2名）进行检查。对于每位牙医为每位患者推荐的治疗方案，首先使用针对每颗被指出需要治疗的牙齿可能的最便宜治疗方法来计算修复治疗的总成本，其次使用每位牙医选择的特定治疗的成本来计算。
使用这两种方法时，发现每位患者的治疗成本在牙医之间存在相当大的差异。所选特定治疗的每位患者中位数成本的平均值比基本治疗的每位患者成本大三倍。很少发现有牙医始终推荐成本较高或较低的治疗方案。
这些发现表明，牙医干预决策和治疗选择的不一致可能对成本产生深远影响。此外，将利用审查重点放在“异常牙医”上，在控制成本和提高质量方面可能远不如全面提高整个行业的一致性有效。
