Vrancken AFJE, Kalmijn S, Buskens E, Franssen H, Vermeulen M, Wokke JHJ, Notermans NC. Feasibility and cost efficiency of a diagnostic guideline for chronic polyneuropathy: a prospective implementation study.
J Neurol Neurosurg Psychiatry 2006;
77:397-401. [PMID:
16484653 PMCID:
PMC2077697 DOI:
10.1136/jnnp.2005.073239]
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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.
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