Eisenberg J M, Williams S V, Garner L, Viale R, Smits H
Med Care. 1977 Nov;15(11):915-21. doi: 10.1097/00005650-197711000-00005.
We developed a computer-bases system to detect inappropriate use of the clinical laboratory and tested a program of physician education to reduce overutilization. We modified the hospital laboratory's computerized reporting system to identify medical patients with three or more determinations of lactic dehydrogenase (LDH) or calcium during the preceding seven days. We audited the charts of these patients, using explicit criteria, to determine whether multiple studies were justified. During the control period 51 per cent of the charts audited for multiple determinations of LDH revealed overutilization. During the study period, when physicians were notified if overutilization was found, 65 per cent of the charts showed overutilization. This difference was not significant. A simultaneous, undisclosed audit of calcium determinations also showed no change between the two periods. Therefore, this method is effective in detecting and measuring overutilization of the laboratory. It is a method which is easily adaptable to a hospital's computerized laboratory reporting system, and it can be applied without a computer. However, our program of notification and education of physicians is not effective in reducing overutilization. More effective methods of modifying physicians' use of laboratory tests need to be developed.
我们开发了一个基于计算机的系统来检测临床实验室的不当使用情况，并测试了一项医生教育计划以减少过度使用。我们修改了医院实验室的计算机报告系统，以识别在过去七天内进行了三次或更多次乳酸脱氢酶（LDH）或钙测定的内科患者。我们使用明确的标准审核这些患者的病历，以确定多项检查是否合理。在对照期，对进行多次LDH测定的病历进行审核，发现51%存在过度使用情况。在研究期，当发现过度使用情况时通知医生，65%的病历显示存在过度使用情况。这种差异不显著。同时，对钙测定进行的未公开审核也显示两个时期之间没有变化。因此，这种方法在检测和衡量实验室的过度使用方面是有效的。它是一种易于应用于医院计算机化实验室报告系统的方法，并且无需计算机即可应用。然而，我们的医生通知和教育计划在减少过度使用方面并不有效。需要开发更有效的方法来改变医生对实验室检查的使用。
