使用临床实践指南（CPG）评估脑室腹腔分流术管理中的医疗实践并控制成本。

The use of clinical practice guidelines (CPGs) to evaluate practice and control costs in ventriculoperitoneal shunt management.

作者信息

Park J K, Frim D M, Schwartz M S, Reidy P, Farley J A, Black P M, Scott R M, Goumnerova L C, Madsen J R

机构信息

Department of Neurosurgery, Children's Hospital, Boston, MA 02115, USA.

出版信息

Surg Neurol. 1997 Dec;48(6):536-41. doi: 10.1016/s0090-3019(97)00364-9.

DOI:10.1016/s0090-3019(97)00364-9

PMID:9400633

Abstract

BACKGROUND

As a step toward maximizing the quality and cost-effectiveness of neurosurgical care, we designed clinical practice guidelines (CPGs) for the management of VP shunt malfunctions and infections at a tertiary care pediatric teaching institution. The detailed CPGs determine the use of radiographic studies, laboratory tests, and invasive procedures in the management of this problem. One purpose of the CPGs is to provide clear clinical guidelines for the medical trainee, thereby reducing variability in care and unnecessary utilization of resources.

METHODS

The CPGs were developed in stages over a 2-year period. The practice patterns in our institution for the management of shunt malfunctions and infections were articulated. They were compared with those published in the neurosurgical literature, and areas of clinical decision-making variability were identified. Preliminary guidelines were formulated, and data regarding patient care were prospectively collected. Based on this data, final CPGs were formulated and implemented. Total and itemized hospital charges for patients managed according to the CPGs were compared with those for patients in the 3 years before CPG implementation.

RESULTS

CPG-managed patients had generally lower total and itemized charges as compared with control patients. Decreased charges per hospital day and charges for shunt films in the CPG group were statistically significant.

CONCLUSIONS

The process by which the CPGs were developed and implemented, as well as the CPGs themselves, are described. We also present the clinical, demographic, and financial data that were prospectively collected for all patients managed within the CPGs over an initial 1-year period and compare it with data obtained for control groups of shunt malfunction patients admitted during the 3 years before implementation of the CPGs. We find a trend toward reduction of charges after implementation of the CPG.

摘要

背景

为了最大限度地提高神经外科护理的质量和成本效益，我们在一家三级儿科教学机构制定了关于脑室腹腔分流术（VP分流术）故障和感染管理的临床实践指南（CPG）。详细的CPG确定了在处理这个问题时影像学检查、实验室检查和侵入性操作的使用。CPG的一个目的是为医学实习生提供明确的临床指南，从而减少护理差异和资源的不必要利用。

方法

CPG在两年时间内分阶段制定。明确了我们机构中处理分流术故障和感染的实践模式。将其与神经外科文献中发表的模式进行比较，并确定临床决策差异的领域。制定了初步指南，并前瞻性地收集了有关患者护理的数据。基于这些数据，制定并实施了最终的CPG。将根据CPG管理的患者的总住院费用和分项费用与CPG实施前三年的患者费用进行比较。