Gehlbach S H, Adamache K W, Cromwell J
School of Public Health and Health Sciences, University of Massachusetts-Amherst 01003-0430, USA.
Inquiry. 1996;33(4):363-72.
This paper examines changes in the use of selected diagnostic technologies for Medicare patients in 1985 and 1990. The analysis compares patients across five common, medical tracer conditions: acute myocardial infarction (AMI), congestive heart failure (CHF), stroke, pneumonia, and gastrointestinal (GI) hemorrhage. The relationship of hospital characteristics to patterns of technology use was assessed by grouping hospitals by a composite measure of "costliness." The overall use of 21 diagnostic tests rose by 27% over the 5-year period. Increases were most marked among the three cardiovascular tracers and for related technologies, such as cardiac angiography and cardiac ultrasound. There was evidence that newer technologies partially replaced older diagnostic tests that were used for similar indications: rates of noninvasive cerebrovascular imaging rose while rates of cerebral angiography declined. However, for several common, long-established tests, such as electrocardiogram and chest radiograph, there were consistent increases that are unexplained. High-cost hospitals performed diagnostic tests at much higher rates than lower-cost hospitals in both 1985 and 1990, but the rate of increase in test use across the two study years was generally greater for the lower-cost hospitals.
本文研究了1985年和1990年医疗保险患者使用特定诊断技术的变化情况。该分析比较了患有五种常见医学示踪疾病的患者：急性心肌梗死（AMI）、充血性心力衰竭（CHF）、中风、肺炎和胃肠道（GI）出血。通过根据“成本高低”的综合指标对医院进行分组，评估了医院特征与技术使用模式之间的关系。在这5年期间，21项诊断测试的总体使用量增长了27%。增长最为显著的是三种心血管示踪剂以及相关技术，如心脏血管造影和心脏超声。有证据表明，新技术部分取代了用于类似适应症的旧诊断测试：无创脑血管成像的使用率上升，而脑血管造影的使用率下降。然而，对于一些常见的、长期使用的测试，如心电图和胸部X光片，其使用率持续上升，原因不明。在1985年和1990年，高成本医院进行诊断测试的比率都远高于低成本医院，但在这两个研究年份中，低成本医院测试使用量的增长率通常更高。
