背景:术语“低价值服务”涉及对患者价值很小或没有价值的医疗保健,因此不应常规提供,或者根本不提供。通过临床指南中的明确建议,可能会取消较低价值的护理。本研究旨在为荷兰提供一份全面的低价值服务清单,以评估护理类型和相关医疗状况。将该列表与NICE不做列表(英国)进行了比较。最后,研究了优先考虑名单的可行性,以确定需要取消收养的条件。
方法:搜索荷兰临床指南(2010年至2015年发布),寻找价值较低的服务。确定的价值较低的服务按护理类型分类(诊断、有和没有药物的治疗),低价值服务的类型(不常规提供或根本不提供),和ICD10代码(国际疾病分类)。该列表按ICD10代码优先排序,根据每个ICD10代码的较低价值服务的数量,患病率,和疾病负担。
结果:在我们研究中包含的193个荷兰指南中发现了总共1366个较低价值的服务。在价值较低的服务中,30%承保诊断,29%主要与不使用药物的手术和药物治疗有关,39%与药物治疗有关。所有低价值服务中的大部分(77%)是在根本不应该提供的护理中,而其他23%的人建议接受不应常规提供的护理。包括价值最低的服务的ICD10章是神经系统的肿瘤和疾病。荷兰指南似乎比英国指南包含更多价值较低的服务。优先排序过程揭示了几个条件,包括背痛,慢性阻塞性肺疾病,缺血性心脏病,最有可能发生较低价值服务的地方,并且有必要取消采用。
结论:在这项研究中,为荷兰医院护理制定了一份全面的低价值服务清单。建立了一种可行的低价值服务优先级排序方法。识别和优先考虑较低价值的服务是减少它们的几个必要步骤中的第一个。
BACKGROUND: The term \'lower value services\' concerns healthcare that is of little or no value to the patient and consequently should not be provided routinely, or not be provided at all. De-adoption of lower value care may occur through explicit recommendations in clinical
guidelines. The present study aimed to generate a comprehensive list of lower value services for the Netherlands that assesses the type of care and associated medical conditions. The list was compared with the NICE do-not-do list (United Kingdom). Finally, the feasibility of prioritizing the list was studied to identify conditions where de-adoption is warranted.
METHODS: Dutch clinical
guidelines (published from 2010 to 2015) were searched for lower value services. The lower value services identified were categorized by type of care (diagnostics, treatment with and without medication), type of lower value service (not routinely provided or not provided at all), and ICD10 codes (international classification of diseases). The list was prioritized per ICD10 code, based on the number of lower value services per ICD10 code, prevalence, and burden of disease.
RESULTS: A total of 1366 lower value services were found in the 193 Dutch
guidelines included in our study. Of the lower value services, 30% covered diagnostics, 29% related to surgical and medical treatment without drugs primarily, and 39% related to drug treatment. The majority (77%) of all lower value services was on care that should not be offered at all, whereas the other 23% recommended on care that should not be offered routinely. ICD10 chapters that included most lower value services were neoplasms and diseases of the nervous system. Dutch
guidelines appear to contain more lower value services than UK
guidelines. The prioritization processes revealed several conditions, including back pain, chronic obstructive pulmonary disease, and ischemic heart diseases, where lower value services most likely occur and de-adoption is warranted.
CONCLUSIONS: In this study, a comprehensive list of lower value services for Dutch hospital care was developed. A feasible method for prioritizing lower value services was established. Identifying and prioritizing lower value services is the first of several necessary steps in reducing them.