Reduction of Laboratory Expenditure Expenditure by Periodic Peer Comparison Feedback to Physicians:Cost-benefit and Durability of Effect

醫師藉由周期性的同儕比較回饋而減少檢驗醫療花費：經濟效益與效果持久度之研究

黃淑蜂(Shu-Feng Huang) ； 喻小珠(Sheau-Ju Yuh) ； 王士叡(Soo-Ray Wang) ； 黃凱琳(Kai-Lin Hwang) ； 趙坤郁(Kun-Yu Chao)

《台灣家庭醫學雜誌》 12卷4期 (2002/12) Pp. 168-178

https://doi.org/10.7023/TJFM.200212.0168

摘要

To investigate the cost-benefit and durability of feedback strategy to physicians for reducing unnecessary laboratory tests and expenditure. A prospective quasi-experimental trial with concurrent comparison group and historical comparison. A medical center in Taiwan. A total of 225,675 patient-visits for 13family physicians and 1,464,748 patient-visits for the 43 enrolled internists, conducted from January 1998 to December 2000. Family physicians received monthly feedback in year 1999 on their use of laboratory tests of the preceding month. Internists(comparison group) received no intervention. Mean number of tests and laboratory expenditure per prescription from 1998to 2000. When compared with prescriptions in year 1998, mean number of tests per prescription in 1999 decreased in both groups(p＜0.01) with a more marked decrease in the intervention group(p＜0.0001), and mean laboratory expenditure per prescription in 1999 decreased in the feedback group(p＜0.01), but increased in the comparison group(p＜0.01). When compared with prescriptions in year 1999, mean number of tests and laboratory expenditure per prescription in 2000 decreased in both groups(p＜0.01) with a more marked decrease in the intervention group(p＜0.0001). The cost of feedback was US$1,588.6. Total saving from reduced tests was US$184,669.5. Periodic peer comparison feedback to physicians on their test-ordering behavior to reduce laboratory expenditure is cost-effective, The effectiveness can persist for at least 1 year after the end of feedback intervention.

並列摘要

To investigate the cost-benefit and durability of feedback strategy to physicians for reducing unnecessary laboratory tests and expenditure. A prospective quasi-experimental trial with concurrent comparison group and historical comparison. A medical center in Taiwan. A total of 225,675 patient-visits for 13family physicians and 1,464,748 patient-visits for the 43 enrolled internists, conducted from January 1998 to December 2000. Family physicians received monthly feedback in year 1999 on their use of laboratory tests of the preceding month. Internists(comparison group) received no intervention. Mean number of tests and laboratory expenditure per prescription from 1998to 2000. When compared with prescriptions in year 1998, mean number of tests per prescription in 1999 decreased in both groups(p＜0.01) with a more marked decrease in the intervention group(p＜0.0001), and mean laboratory expenditure per prescription in 1999 decreased in the feedback group(p＜0.01), but increased in the comparison group(p＜0.01). When compared with prescriptions in year 1999, mean number of tests and laboratory expenditure per prescription in 2000 decreased in both groups(p＜0.01) with a more marked decrease in the intervention group(p＜0.0001). The cost of feedback was US$1,588.6. Total saving from reduced tests was US$184,669.5. Periodic peer comparison feedback to physicians on their test-ordering behavior to reduce laboratory expenditure is cost-effective, The effectiveness can persist for at least 1 year after the end of feedback intervention.

並列關鍵字

feedback ； diagnostic tests ； health expenditures ； intervention studies ； cost-benefit analysis

參考文獻

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