慢性多发性神经病变诊断标准的可行性和成本效益:一项前瞻性的应用研究

Feasibility and cost efficiency of a diagnostic guideline for chronic polyneuropathy: A prospective implementation study

Background: Extensive investigations are often performed to reveal the cause of chronic polyneuropathy. It is not known whether a restrictive diagnostic guideline improves cost efficiency without loss of diagnostic reliability. Methods: In a prospective multicentre study, a comparison was made between the workup in patients with chronic polyneuropathy before and after guideline implementation. Results: Three hundred and ten patients were included: 173 before and 137 after g uideline implementation. In all patients, the diagnosis would remain the same if the workup was limited to the investigations in the guideline. After guideline implementation, the time to reach a diagnosis decreased by two weeks. There was a reduction of 33%in the number and costs of routine laboratory inves tigations/patient, and a reduction of 27%in the total number of laboratory tests/patient, despite low guideline adherence. Conclusion: The implementation of a diagnostic guideline for chronic polyneuropathy can reduce diagnostic delay an d the number and costs of investigations for each patient without loss of diag nostic reliability. Continuous evaluation strategies after guideline implementat ion may improve guideline adherence and cost efficiency.

Background： Extensive investigations are often performed to reveal the cause of chronic polyneuropathy. It is not known whether a restrictive diagnostic guideline improves cost efficiency without loss of diagnostic reliability. Methods： In a prospective multieentre study, a comparison was made between the workup in patients with chronic polyneuropathy before and after guideline implementation. Results： Three hundred and ten patients were included： 173 before and 137 after guideline implementation. In all patients, the diagnosis would remain the same if the workup was limited to the investigations in the guideline. After guideline implementation, the time to reach a diagnosis decreased by two weeks. There was a reduction of 33% in the number and costs of routine laboratory inves tigations/patient, and a reduction of 27% in the total number of laboratory tests/patient, despite low guideline adherence. Conclusion： The implementation of a diagnostic guideline for chronic polyneuropathy can reduce diagnostic delay and the number and costs of investigations for each patient without loss of diagnostic reliability. Continuous evaluation strategies after guideline implementation may improve guideline adherence and cost efficiency.