Freeborn D K, Shye D, Mullooly J P, Eraker S, Romeo J
Kaiser Permanente, Center for Health Research, Northwest Division, Portland, Ore. 97227, USA.
J Gen Intern Med. 1997 Oct;12(10):619-25. doi: 10.1046/j.1525-1497.1997.07122.x.
To reduce variability in primary care physicians' use of procedures for imaging the lumbar spine.
Controlled intervention using clinical practice guideline and practice pattern feedback.
Sixty-seven internists and 28 family practitioners in a large, group-model HMO.
Intervention group physicians received the clinical practice guideline for low back pain, followed after 4 months by three bimonthly feedback reports on their current use rates for lumber spine x-rays and computed tomography and magnetic resonance imaging scans of the lumbar spine. Control group physicians received neither the guideline nor the feedback reports. Automated radiology utilization data were used to compare intervention and control group physicians' changes in use rates and variability in use rates over the course of the study period. Neither the guideline alone nor the guideline plus feedback was associated with a significant decrease in use rates or in the variability in use rates for the lumbar spine imaging procedures under study.
Clinical practice guidelines and practice pattern feedback fail to achieve their goals when features of the practice setting and patient expectations and behavior are not identified and addressed.
减少基层医疗医生在使用腰椎成像检查程序方面的差异。
采用临床实践指南和实践模式反馈的对照干预。
一家大型团体模式健康维护组织中的67名内科医生和28名家庭医生。
干预组医生收到了腰痛临床实践指南，4个月后又收到了三份关于他们当前腰椎X线、计算机断层扫描和磁共振成像扫描使用率的双月反馈报告。对照组医生既未收到指南也未收到反馈报告。利用自动化放射学利用数据比较干预组和对照组医生在研究期间使用率的变化以及使用率的差异。单独的指南或指南加反馈均与所研究的腰椎成像检查程序的使用率或使用率差异的显著降低无关。
当未识别和解决实践环境的特征以及患者的期望和行为时，临床实践指南和实践模式反馈无法实现其目标。
