Shared patient analysis: a method to assess the clinical benefits of patient referrals.
Med Care
; 39(11): 1182-7, 2001 Nov.
Article
em En
| MEDLINE
| ID: mdl-11606872
ABSTRACT
BACKGROUND:
Referral to specialized physicians or institutions often is deemed necessary in clinical medicine, but no method exists to assess the clinical benefit of such referrals.OBJECTIVES:
To describe a method, which is shared patient analysis, to measure the expected improvement in clinical management associated with referrals and to apply that method in the field of abdominal and pelvic oncological radiology.SUBJECTS:
All patients referred, during a 4-year period, to surgical oncologists at four academic centers (the referral providers, or RPs) with radiographs performed before referral at a community site (the initial providers, or IPs). Patients (n = 396) for whom both the IP interpretation and a final diagnosis was available were eligible. All IP and RP readings were placed in random order and presented to surgical oncologists, who then recommended a treatment course. MEASUREMENTS Diagnostic accuracy of the IP and RP readings and the proportion of patients who were assigned to an appropriate treatment by the oncologist were determined.RESULTS:
When the indication for imaging was primary diagnosis or staging, the kappa for presence of cancer was 0.70. When the indication was cancer follow-up, the kappa for presence of recurrent/progressing cancer was 0.66. There were disagreements between the IP and RP radiologists over the interpretation of 162 films, with the RP radiologists being correct in 153 (94%). Had the patients been treated using IP readings, there would have been 19 more inappropriate surgeries and 19 more admissions (both P <0.05) than if the oncologists had based their recommendations on RP readings.CONCLUSIONS:
The technique of shared patient analysis permits assessment of the clinical benefits associated with referrals.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Planejamento de Assistência ao Paciente
/
Garantia da Qualidade dos Cuidados de Saúde
/
Encaminhamento e Consulta
/
Serviço Hospitalar de Oncologia
/
Neoplasias
Tipo de estudo:
Clinical_trials
/
Guideline
Limite:
Female
/
Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Med Care
Ano de publicação:
2001
Tipo de documento:
Article
País de afiliação:
Estados Unidos