Feasibility and cost efficiency of a diagnostic guideline for chronic polyneuropathy: a prospective implementation study
- 26 July 2005
- journal article
- research article
- Published by BMJ in Journal of Neurology, Neurosurgery & Psychiatry
- Vol. 77 (3), 397-401
- https://doi.org/10.1136/jnnp.2005.073239
Abstract
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 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 investigations/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.Keywords
This publication has 24 references indexed in Scilit:
- Follow up of patients with signs and symptoms of polyneuropathy not confirmed by electrophysiological studiesJournal of Neurology, Neurosurgery & Psychiatry, 2005
- Block design allowed for control of the Hawthorne effect in a randomized controlled trial of test orderingJournal of Clinical Epidemiology, 2004
- A controlled investigation of the cause of chronic idiopathic axonal polyneuropathyBrain, 2004
- Evaluating patients with suspected peripheral neuropathy: Do the right thing, not everythingMuscle & Nerve, 2002
- Regular review: Peripheral neuropathyBMJ, 2002
- Evaluation of Patients With Symptoms Suggestive of Chronic PolyneuropathyJournal of Clinical Neuromuscular Disease, 2001
- Diagnostic investigation of patients with chronic polyneuropathy: evaluation of a clinical guidelineJournal of Neurology, Neurosurgery & Psychiatry, 2001
- Investigation of peripheral neuropathy.Journal of Neurology, Neurosurgery & Psychiatry, 1995
- Chronic idiopathic axonal polyneuropathy: a five year follow up.Journal of Neurology, Neurosurgery & Psychiatry, 1994
- Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluationsThe Lancet, 1993