{"id":145,"date":"2018-09-25T10:00:13","date_gmt":"2018-09-25T01:00:13","guid":{"rendered":"http:\/\/spell.umin.jp\/thespellblog\/?p=145"},"modified":"2018-09-25T23:13:14","modified_gmt":"2018-09-25T14:13:14","slug":"choosing-wisely%e3%81%af%e3%81%a9%e3%82%8c%e3%81%a0%e3%81%91%e5%bd%b9%e3%81%ab%e7%ab%8b%e3%81%a3%e3%81%a6%e3%81%84%e3%82%8b%e3%81%ae%e3%81%8b","status":"publish","type":"post","link":"https:\/\/spell.umin.jp\/thespellblog\/?p=145","title":{"rendered":"Choosing Wisely\u00ae\u306f\u3069\u308c\u3060\u3051\u5f79\u306b\u7acb\u3063\u3066\u3044\u308b\u306e\u304b"},"content":{"rendered":"
\"\"<\/div>\n

2010\u5e74\uff0cInstitute for the Medical Humanities\u6240\u9577\u3067\u30c6\u30ad\u30b5\u30b9\u5927\u5b66\u5bb6\u5ead\u533b\u5b66\u79d1\u6559\u6388\u306eBrody H\u6c0f\u304c\uff0cN Engl J Med\u8a8c\u306b\u300cMedicine’s ethical responsibility for health care reform\uff0d the top five list\u300d1<\/sup>\u3092\u63b2\u8f09\u3057\u305f\uff0e\u7fcc2011\u5e74\uff0c\u904e\u5270\u533b\u7642\u306e\u6291\u5236\u3068\u9069\u6b63\u5316\u3092\u76ee\u7684\u3068\u3057\u3066\u7c73\u56fd\u5185\u79d1\u5c02\u9580\u533b\u6a5f\u69cb (ABIM)\u8ca1\u56e3\u304c\u59cb\u3081\u305fChoosing Wisely\u00ae\u30ad\u30e3\u30f3\u30da\u30fc\u30f3\u306f\uff0c\u4e16\u754c\u5404\u56fd\u306b\u305d\u306e\u8f2a\u3092\u5e83\u3052\u3066\u3044\u3063\u305f\uff0e\u308f\u304c\u56fd\u3067\u3082\uff0c2016 \u5e7410 \u6708\u306b\u533b\u5e2b\uff0c\u85ac\u5264\u5e2b\uff0c\u533b\u5b66\u751f\uff0c\u60a3\u8005\u30fb\u5e02\u6c11\u306a\u3069\uff0c\u3055\u307e\u3056\u307e\u306a\u7acb\u5834\u306e12\u4eba\u304c\u96c6\u307e\u308a\uff0cChoosing Wisely Japan2<\/sup>\u304c\u8a2d\u7acb\u3055\u308c\u305f\uff0e\u73fe\u5728\uff0c80\u4ee5\u4e0a\u306e\u5b66\u8853\u56e3\u4f53\u306a\u3069\u304c\uff0c\u30a8\u30d3\u30c7\u30f3\u30b9\u306b\u57fa\u3065\u3044\u305f550\u4ee5\u4e0a\u306e\u63a8\u5968\u3092\u63d0\u793a\u3057\u3066\u3044\u308b\uff0e\u9806\u98a8\u6e80\u5e06\u306b\u898b\u3048\u308b\u30ad\u30e3\u30f3\u30da\u30fc\u30f3\u3060\u304c\uff0cEBM\u306e\u7acb\u5834\u304b\u3089\u898b\u308b\u3068\uff0c\u5fc5\u305a\u3057\u3082\u3046\u307e\u304f\u3044\u3063\u3066\u3044\u308b\u3068\u306f\u8a00\u3044\u5207\u308c\u306a\u3044\uff0e\u672c\u7a3f\u3067\u306f\uff0cChoosing Wisely\u00ae\u306e\u5f71\u306e\u90e8\u5206\u306b\u7126\u70b9\u3092\u5f53\u3066\u3066\u8ad6\u3058\u3066\u307f\u305f\u3044\uff0e<\/p>\n

Choosing Wisely\u00ae<\/strong>\u306f\u533b\u7642\u306e\u8cea\u3092\u6539\u5584\u3057\uff0c\u30b1\u30a2\u306e\u30b3\u30b9\u30c8\u3092\u4e0b\u3052\u308b\u3082\u306e\u304b\uff1f<\/strong><\/h2>\n

\u547c\u5438\u5668\u30fb\u96c6\u4e2d\u6cbb\u7642\u9818\u57df\u306eChoosing Wisely\u30ea\u30b9\u30c8\u306f2014\u5e74\u306b\u516c\u8868\u3055\u308c\u305f\u304c\uff0c\u305d\u308c\u3089\u306e\u30ea\u30b9\u30c8\u304c\u533b\u7642\u306e\u8cea\u306e\u6539\u5584\u3084\u30b1\u30a2\u306e\u30b3\u30b9\u30c8\u306e\u4f4e\u4e0b\u306b\u5bc4\u4e0e\u3057\u305f\u304b\u306b\u3064\u3044\u3066\u691c\u8a0e\u3057\u305f\u8ad6\u65873<\/sup>\u304c\u767a\u8868\u3055\u308c\u305f\uff0e\u3053\u306e\u8ad6\u6587\u306b\u3088\u308b\u3068\uff0cChoosing Wisely\u00ae\u306e\u63a8\u5968\u304c\u30b3\u30b9\u30c8\u3084\u533b\u7642\u306e\u8cea\u306b\u5f71\u97ff\u3059\u308b\u6761\u4ef6\u3068\u3057\u3066\u306f\uff0c\u2460\u3053\u308c\u307e\u3067\u30ea\u30b9\u30c8\u306b\u53cd\u3059\u308b\u8a3a\u7642\u3092\u884c\u3063\u3066\u3044\u305f\u304c\uff0c\u610f\u601d\u6c7a\u5b9a\u306e\u969b\u306b\u30ea\u30b9\u30c8\u3092\u9075\u5b88\u3059\u308b\u3088\u3046\u306b\u306a\u3063\u305f\u3053\u3068\u3068\uff0c\u2461\u305d\u306e\u610f\u601d\u6c7a\u5b9a\u304c\u4f4e\u4fa1\u683c\u3067\u30b1\u30a2\u306e\u8cea\u3092\u6539\u5584\u3059\u308b\u3053\u3068\u304c\u5fc5\u8981\u3068\u3055\u308c\u3066\u3044\u308b\uff0e\u3057\u304b\u3057\u5b9f\u969b\u306b\u306f\uff0c\u307b\u3068\u3093\u3069\u884c\u52d5\u306f\u5909\u308f\u3063\u3066\u304a\u3089\u305a\uff0c\u30b3\u30b9\u30c8\u3084\u533b\u7642\u306e\u8cea\u3078\u306e\u5f71\u97ff\u3082\u5f53\u521d\u306e\u4e88\u60f3\u3088\u308a\u3082\u5c0f\u3055\u3044\u3053\u3068\u304c\u5206\u304b\u3063\u305f\u3068\u3044\u3046\uff0e<\/p>\n

\u533b\u5e2b\u306e\u884c\u52d5\u304c\u5909\u308f\u3089\u306a\u3044\u7406\u7531\u306b\u306f\u3044\u304f\u3064\u304b\u3042\u308b\u304c\uff0c\u307e\u305a\uff0c\u300c5\u3064\u306e\u30ea\u30b9\u30c8\u300d\u306e\u6839\u62e0\u3068\u3055\u308c\u308b\u30a8\u30d3\u30c7\u30f3\u30b9\u304c\uff0c\u30b7\u30b9\u30c6\u30de\u30c6\u30a3\u30c3\u30af\u30ec\u30d3\u30e5\u30fc\u306b\u3088\u3063\u3066\u4f5c\u3089\u308c\u305f\u3082\u306e\u3067\u306a\u304f\uff0c\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u30b0\u30ec\u30fc\u30c9\u8a55\u4fa1\u306b\u3064\u3044\u3066\u900f\u660e\u6027\u306b\u6b20\u3051\u308b\u3068\u6307\u6458\u3055\u308c\u3066\u3044\u305f\uff0e\u307e\u305f\uff0c\u5f15\u7528\u3055\u308c\u305f\u6587\u732e\u306e\u6279\u5224\u7684\u541f\u5473\u3082\u306a\u3055\u308c\u3066\u3044\u306a\u304b\u3063\u305f\uff0e\u533b\u5e2b\u81ea\u8eab\u306b\u5f53\u4e8b\u8005\u610f\u8b58\u304c\u306a\u304f\uff0c\u30b3\u30b9\u30c8\u3092\u6e1b\u3089\u3057\uff0c\u7121\u99c4\u306a\u533b\u7642\u884c\u70ba\u3092\u3084\u3081\u308b\u3053\u3068\u306b\u3064\u3044\u3066\u306e\u8cac\u4efb\u611f\u3092\u6301\u305f\u306a\u3044\u3053\u3068\u3082\u539f\u56e0\u3060\u3068\u3044\u3046\uff0e<\/p>\n

\u306a\u305c<\/strong>Choosing Wisely\u00ae<\/strong>\u306f\u533b\u5e2b\u306e\u884c\u52d5\u3092\u5909\u3048\u306a\u3044\u306e\u304b\uff1f<\/strong><\/h2>\n

\u4eca\u5e743\u6708\u306b\u767a\u8868\u3055\u308c\u305f\u8ad6\u65874<\/sup>\u3067\u306f\uff0c Choosing Wisely\u00ae\u304c\u533b\u5e2b\u306e\u884c\u52d5\u3092\u5909\u3048\u306a\u3044\u7406\u7531\u3068\u3057\u30668\u3064\u6319\u3052\u3066\u3044\u308b\uff0e<\/p>\n

1\uff09\u79c1\u305f\u3061\u306e\u60a3\u8005\u306f\uff0c\u75db\u307f\uff0c\u4e0d\u5b89\uff0c\u9577\u671f\u9593\u306e\u5f85\u6a5f\u6642\u9593\u306a\u3069\uff0c\u591a\u304f\u306e\u539f\u56e0\u306b\u3088\u308b\u82e6\u75db\u306b\u5f71\u97ff\u3092\u53d7\u3051\u308b\uff0e\u5f7c\u3089\u306e\u671f\u5f85\u306b\u691c\u67fb\u3084\u6cbb\u7642\u304c\u542b\u307e\u308c\u308b\u3053\u3068\u304c\u3042\u308b\u305f\u3081\uff0c\u30a8\u30d3\u30c7\u30f3\u30b9\u304c\u4e4f\u3057\u3044\u3053\u3068\u3084\u30b3\u30b9\u30c8\u304c\u6291\u5236\u3067\u304d\u308b\u3053\u3068\u3092\u8a71\u3057\u3066\u3082\u7d0d\u5f97\u3057\u3066\u3082\u3089\u3048\u306a\u3044\u306e\u3067\u3042\u308b\uff0e<\/p>\n

2\uff09\u591a\u304f\u306e\u691c\u67fb\u304c\uff0c\u305d\u308c\u3092\u884c\u3046\u3053\u3068\u3067\u9ad8\u3044\u53ce\u76ca\u304c\u5f97\u3089\u308c\u308b\uff0e\u305d\u306e\u4e00\u65b9\u3067\uff0c\u591a\u304f\u306eChoosing Wisely\u00ae\u306e\u63a8\u5968\u306b\u3064\u3044\u3066\u60a3\u8005\u3068\u8a71\u3057\u3066\u3082\uff0c\u305d\u306e\u52b4\u529b\u306b\u898b\u5408\u3046\u52b9\u679c\u304c\u306a\u3044\u3053\u3068\u3092\uff0c\u81e8\u5e8a\u73fe\u5834\u3067\u306f\u3057\u3070\u3057\u3070\u7d4c\u9a13\u3059\u308b\uff0e\u4f8b\u3048\u3070\uff0c\u982d\u75db\u3092\u4e3b\u8a34\u306b\u53d7\u8a3a\u3057\u305f\u60a3\u8005\u306b\uff0c\u4e01\u5be7\u306b\u75c5\u6b74\u3092\u8074\u3044\u3066\u6a5f\u80fd\u6027\u982d\u75db\u3060\u3068\u8a3a\u65ad\u3057\u3066\u3082\uff0c\u300c\u304f\u3082\u819c\u4e0b\u51fa\u8840\u304c\u5fc3\u914d\u306a\u306e\u3067\u982d\u90e8CT\u3092\u64ae\u5f71\u3057\u3066\u6b32\u3057\u3044\u300d\u3068\u3044\u3046\u5e0c\u671b\u3092\u8986\u3059\u306b\u306f\u81f3\u3089\u306a\u3044\uff0e\u8aac\u660e\u3092\u3057\u3066\u3082\u3057\u306a\u304f\u3066\u3082\uff0c\u7d50\u5c40\uff0c\u982d\u90e8CT\u3092\u64ae\u5f71\u3059\u308b\u3053\u3068\u306b\u306a\u308b\u306e\u3067\uff0c\u8aac\u660e\u3059\u308b\u3060\u3051\u5f92\u52b4\u306b\u7d42\u308f\u308b\u306e\u3067\u3042\u308b\uff0e\u305d\u3053\u3067\u3082\u3057\u610f\u5730\u3092\u5f35\u3063\u3066\u982d\u90e8CT\u3092\u64ae\u3089\u306a\u304b\u3063\u305f\u3068\u3057\u305f\u3089\uff0c\u60a3\u8005\u306f\u6e80\u8db3\u304c\u5f97\u3089\u308c\u306a\u3044\u3070\u304b\u308a\u304b\uff0c\u75c5\u9662\u304b\u3089\u306e\u5e30\u308a\u9053\u306b\u5225\u306e\u75c5\u9662\u3092\u53d7\u8a3a\u3057\u3066\u3057\u307e\u3046\u3060\u308d\u3046\uff0e<\/p>\n

3\uff09Choosing Wisely\u00ae\u306e\u63a8\u5968\u306f\uff0c\u5927\u5b66\u6559\u6388\u306a\u3069\uff0c\u4e3b\u306b\u5b66\u8005\u3067\u3042\u308b\u533b\u5e2b\u306b\u3088\u3063\u3066\u7b56\u5b9a\u3055\u308c\u3066\u3044\u308b\u306e\u3067\uff0c\u73fe\u5834\u306e\u6700\u524d\u7dda\u306b\u3044\u308b\u533b\u5e2b\u306e\u611f\u899a\u3068\u4e56\u96e2\u3057\u3066\u3044\u308b\uff0e\u3044\u308f\u3086\u308bevidence-practice gap\u3068\u547c\u3070\u308c\u308b\u3082\u306e\u3067\uff0c\u7814\u7a76\u3067\u5bfe\u8c61\u3068\u306a\u3063\u305f\u60a3\u8005\u306f\u4e00\u822c\u306e\u60a3\u8005\u3092\u5fc5\u305a\u3057\u3082\u4ee3\u8868\u3057\u3066\u3044\u306a\u3044\u305f\u3081\uff0c\u73fe\u5834\u306b\u305d\u3050\u308f\u306a\u3044\u63a8\u5968\u306b\u306a\u3063\u3066\u3044\u308b\u3053\u3068\u304c\u3042\u308b\uff0e<\/p>\n

4\uff09Choosing Wisely\u00ae\u306e\u672c\u6765\u306e\u76ee\u7684\u306f\uff0c\u507d\u967d\u6027\u3084\u4ed6\u306e\u533b\u539f\u6027\u306e\u5bb3\u306e\u30ea\u30b9\u30af\u3092\u907f\u3051\u308b\u3053\u3068\u3067\u3042\u308b\uff0e\u3057\u304b\u3057\uff0c\u30b3\u30b9\u30c8\u524a\u6e1b\u306e\u52b9\u679c\u3070\u304b\u308a\u304c\u6ce8\u76ee\u3055\u308c\uff0cChoosing Wisely\u00ae\u304c\u5fc5\u8981\u306a\u533b\u7642\u307e\u3067\u524a\u3063\u3066\u3057\u307e\u3046\u3068\u8aa4\u89e3\u3055\u308c\u3066\u3044\u308b\uff0e<\/p>\n

5\uff09Choosing Wisely\u00ae\u306f\u63a8\u5968\u3092\u63d0\u793a\u3059\u308b\u3082\u306e\u3060\u304c\uff0c\u307b\u3068\u3093\u3069\u306e\u5834\u5408\uff0c\u5b9f\u969b\u306b\u305d\u306e\u63a8\u5968\u304c\u9042\u884c\u3055\u308c\u3066\u3044\u308b\u304b\u306e\u30e2\u30cb\u30bf\u30ea\u30f3\u30b0\u306f\u4e0d\u5341\u5206\u3067\uff0c\u4fe1\u983c\u6027\u306e\u9ad8\u3044\u76e3\u67fb\u3084\u30d5\u30a3\u30fc\u30c9\u30d0\u30c3\u30af\u304c\u306a\u3055\u308c\u3066\u3044\u306a\u3044\uff0e\u305d\u306e\u305f\u3081\uff0c\u77e5\u8b58\u3068\u3057\u3066\u306f\u77e5\u3063\u3066\u3044\u3066\u3082\uff0c\u5b9f\u884c\u3055\u308c\u3066\u3044\u306a\u304b\u3063\u305f\u308a\uff0c\u4fa1\u5024\u306e\u4f4e\u3044\u4ecb\u5165\u304c\u4e71\u7528\u3055\u308c\u305f\u308a\u3057\u3066\u3044\u308b\uff0e<\/p>\n

6\uff09\u4e00\u90e8\u306eChoosing Wisely\u00ae\u306e\u63a8\u5968\u306f\uff0c\u4fe1\u983c\u3067\u304d\u308b\u30a8\u30d3\u30c7\u30f3\u30b9\u306b\u57fa\u3065\u3044\u3066\u304a\u3089\u305a\uff0c\u3042\u308b\u3044\u306f\uff0c\u63a8\u5968\u304c\u767a\u8868\u3055\u308c\u305f\u5f8c\u306b\u76f8\u53cd\u3059\u308b\u65b0\u305f\u306a\u30a8\u30d3\u30c7\u30f3\u30b9\u304c\u767a\u8868\u3055\u308c\u3066\u3082\uff0c\u4fee\u6b63\u3055\u308c\u308b\u3053\u3068\u304c\u306a\u3044\uff0e\u7279\u306b\uff0c1\u672c\u306e\u8ad6\u6587\uff0c\u305d\u308c\u3082\u75c7\u4f8b\u96c6\u7a4d\u7814\u7a76\u3084\u75c7\u4f8b\u5bfe\u7167\u7814\u7a76\u306e\u3088\u3046\u306a\u9811\u5f37\u3055\u306e\u4f4e\u3044\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u306e\u8ad6\u6587\u3092\u5f15\u7528\u3057\u3066\u63a8\u5968\u3092\u4f5c\u6210\u3057\u3066\u3044\u308b\u3088\u3046\u306a\u5834\u5408\uff0c\u305d\u308c\u306f\u305f\u307e\u305f\u307e\u767a\u8868\u3055\u308c\u305f\u5831\u544a\u3067\u3042\u308a\uff0c\u7570\u306a\u308b\u7d50\u8ad6\u3092\u793a\u3059\u8ad6\u6587\u304c\u5225\u306b\u5b58\u5728\u3057\u3066\u3044\u308b\u304b\u3082\u3057\u308c\u306a\u3044\uff0e<\/p>\n

7\uff09Choosing Wisely\u00ae\u306e\u63a8\u5968\u3067\u6271\u308f\u308c\u3066\u3044\u308b\u4fa1\u5024\u306e\u4f4e\u3044\u4ecb\u5165\u304c\uff0c\u3069\u306e\u304f\u3089\u3044\u5b9f\u65bd\u3055\u308c\u3066\u3044\u308b\u304b\u628a\u63e1\u3055\u308c\u3066\u304a\u3089\u305a\uff0c\u5b9f\u306f\u3082\u3068\u3082\u3068\u305d\u308c\u307b\u3069\u884c\u308f\u308c\u3066\u3044\u306a\u3044\u53ef\u80fd\u6027\u304c\u3042\u308b\uff0e\u307e\u305f\uff0c\u5408\u7406\u7684\u306a\u30d9\u30f3\u30c1\u30de\u30fc\u30af\u3084\u76ee\u6a19\u304c\u4e0d\u660e\u3067\uff0c\u3069\u306e\u7a0b\u5ea6\u9054\u6210\u3055\u308c\u3066\u3044\u308c\u3070\u826f\u3044\u304b\u306e\u6307\u6a19\u304c\u793a\u3055\u308c\u3066\u3044\u306a\u3044\u305f\u3081\uff0c\u63a8\u5968\u304b\u3089QI\u6226\u7565\u306b\u79fb\u884c\u3059\u308b\u3053\u3068\u304c\u56f0\u96e3\u3067\u3042\u308b<\/p>\n

8\uff09Choosing Wisely\u00ae\u306e\u8a8d\u77e5\u5ea6\u304c\u4f4e\u304f\uff0c\u4e00\u822c\u306b\u306f\u6d78\u900f\u3057\u3066\u3044\u306a\u3044\uff0e\u7c73\u56fd\u306e\u8abf\u67fb\u3067\u306f\uff0c\u6551\u6025\u533b\u306f\u3069\u308c\u304c\u6b63\u3057\u3044Choosing Wisely\u00ae\u63a8\u5968\u304b\u3092\u8a00\u3044\u5f53\u3066\u308b\u3053\u3068\u304c\u307b\u3068\u3093\u3069\u3067\u304d\u306a\u304b\u3063\u305f\u3068\u3055\u308c\u3066\u3044\u308b\uff0e<\/p>\n

\u4ee5\u4e0a\u306e\u3088\u3046\u306b\uff0cChoosing Wisely\u00ae\u304c\u533b\u5e2b\u306e\u884c\u52d5\u3092\u5909\u3048\u306a\u3044\u7406\u7531\u306b\u306f\u3055\u307e\u3056\u307e\u306a\u3082\u306e\u304c\u3042\u308a\uff0c\u5358\u306b\u63a8\u5968\u3092\u4f5c\u6210\u3057\u3066\u516c\u8868\u3059\u308b\u3060\u3051\u3067\u306f\uff0c\u5b9f\u52b9\u6027\u306b\u4e4f\u3057\u3044\u3068\u3044\u3048\u308b\uff0e<\/p>\n

Choosing Wisely\u00ae<\/strong>\u306e\u63a8\u5968\u306f\u672c\u5f53\u306b\u30a8\u30d3\u30c7\u30f3\u30b9\u306b\u57fa\u3065\u3044\u3066\u3044\u308b\u306e\u304b\uff1f<\/strong><\/h2>\n

\u4eca\u5e744\u6708\u306b\u767a\u8868\u3055\u308c\u305f\u8ad6\u65875<\/sup>\u3067\u306f\uff0c2014\u5e748\u6708\u307e\u3067\u306b\u516c\u8868\u3055\u308c\u305f320\u306e\u63a8\u5968\u306b\u3064\u3044\u3066\uff0c\u305d\u306e\u6839\u62e0\u3068\u306a\u308b\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u5f37\u3055\u3068\u5f15\u7528\u3055\u308c\u3066\u3044\u308b\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3092\uff0c\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u8a55\u4fa1\u306e\u56fd\u969b\u6a19\u6e96\u30c4\u30fc\u30eb\u3067\u3042\u308bAGREE\u21616<\/sup>\u3092\u7528\u3044\u3066\u8a55\u4fa1\u3057\u305f\uff0e\u305d\u306e\u7d50\u679c\uff0c\u5168\u63a8\u5968\u306e70.3%\u304c\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3092\u5f15\u7528\u3057\u3066\u304a\u308a\uff0c22.2%\u306f\u4e00\u6b21\u7814\u7a76\u3092\u6700\u9ad8\u30ec\u30d9\u30eb\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u3068\u3057\u3066\u5f15\u7528\u3057\u3066\u3044\u305f\uff0e\u4e00\u65b9\uff0c7.8%\u306f\u75c7\u4f8b\u96c6\u7a4d\u7814\u7a76\uff0c\u7dcf\u8aac\uff0c\u30a8\u30c7\u30a3\u30c8\u30ea\u30a2\u30eb\u3084\u8cea\u306e\u4f4e\u3044\u30c7\u30fc\u30bf\u3092\u6700\u9ad8\u30ec\u30d9\u30eb\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u3068\u3057\u3066\u5f15\u7528\u3057\u3066\u3044\u305f\uff0e\u3064\u307e\u308a\uff0c\u6a2a\u4e26\u3073\u3067\u793a\u3055\u308c\u3066\u3044\u308b\u63a8\u5968\u3067\u3042\u3063\u3066\u3082\uff0c\u305d\u306e\u6839\u62e0\u3068\u306a\u308b\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u306f\u307e\u3061\u307e\u3061\u3067\u3042\u308b\u3053\u3068\u304c\u308f\u304b\u308b\uff0e<\/p>\n

\u3055\u3089\u306b\uff0c\u6839\u62e0\u3068\u3057\u3066\u63a1\u7528\u3055\u308c\u3066\u3044\u308b23\u4ef6\u306e\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3092AGREE\u2161\u3067\u8a55\u4fa1\u3057\u305f\u3068\u3053\u308d\uff0c\u7dcf\u30b9\u30b3\u30a2\u306e\u4e2d\u592e\u5024\u306f54.2%\uff08IQR 33.3\uff5e70.8%\uff09\u3060\u3063\u305f\uff0eAGREE\u2161\u306f\uff0c\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u304c\u3069\u306e\u3088\u3046\u306b\u4f5c\u3089\u308c\u305f\u3082\u306e\u304b\u3068\u3044\u3046\u5f62\u5f0f\u8a55\u4fa1\u3092\u3059\u308b\u3082\u306e\u3067\u3042\u308a\uff0c\u300c\u5bfe\u8c61\u3068\u76ee\u7684\u300d\uff0c\u300c\u5229\u5bb3\u95a2\u4fc2\u8005\u306e\u53c2\u52a0\u300d\uff0c\u300c\u4f5c\u6210\u306e\u53b3\u683c\u3055\u300d\uff0c\u300c\u63d0\u793a\u306e\u660e\u78ba\u3055\u300d\uff0c\u300c\u9069\u7528\u53ef\u80fd\u6027\u300d\uff0c\u300c\u7de8\u96c6\u306e\u72ec\u7acb\u6027\u300d\u306e6\u3064\u306e\u30c9\u30e1\u30a4\u30f3\u306b\u5206\u304b\u308c\u305f23\u306e\u9805\u76ee\u3067\u8a55\u4fa1\u304c\u884c\u308f\u308c\u308b\uff0e\u305d\u3057\u3066\uff0c\u5404\u9805\u76ee\u306e\u5185\u5bb9\u304c\u3069\u308c\u304f\u3089\u3044\u6e80\u305f\u3055\u308c\u3066\u3044\u308b\u304b\u30921\uff5e7\u306e7\u6bb5\u968e\u3067\u8a55\u4fa1\u3057\uff0c\u6700\u7d42\u7684\u306b\u306f\uff0c\u30c9\u30e1\u30a4\u30f3\u3054\u3068\u306b\u3069\u308c\u3060\u3051\u5145\u8db3\u3057\u3066\u3044\u308b\u304b\uff0c\u5145\u8db3\u7387\u30920\uff5e100%\u3067\u8868\u8a18\u3059\u308b\uff0e\u7dcf\u30b9\u30b3\u30a2\u306e\u4e2d\u592e\u5024\u304c54.2%\u3068\u3044\u3046\u3053\u3068\u306f\uff0c\u8981\u6c42\u3055\u308c\u3066\u3044\u308b\u5185\u5bb9\u306e\u534a\u5206\u7a0b\u5ea6\u3057\u304b\u9054\u6210\u3055\u308c\u3066\u3044\u306a\u3044\u3053\u3068\u3092\u793a\u3059\uff0e\u3053\u306e\u5145\u8db3\u7387\u306f\uff0c\u7c73\u56fd\u306e\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306e\u5e73\u5747\u7a0b\u5ea6\u3068\u8a00\u3048\uff0c\u82f1\u56fd\u306e\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u307b\u3069\u9ad8\u3044\u3082\u306e\u3067\u306f\u306a\u30447<\/sup>\uff0e<\/p>\n

\u3064\u307e\u308a\uff0cChoosing Wisely\u00ae\u306e\u63a8\u5968\u306e\u6839\u62e0\u3068\u306a\u3063\u3066\u3044\u308b\u30a8\u30d3\u30c7\u30f3\u30b9\u306f\u5fc5\u305a\u3057\u3082\u8cea\u304c\u9ad8\u3044\u3068\u306f\u3044\u3048\u305a\uff0c\u307e\u305f\u3070\u3089\u3064\u304d\u3082\u3042\u308a\uff0c\u3059\u3079\u3066\u3092\u540c\u5217\u3067\u306f\u6271\u3048\u306a\u3044\u3068\u3044\u3046\u554f\u984c\u304c\u3042\u308b\uff0e<\/p>\n

Choosing Wisely\u00ae<\/strong>\u3092\u5f79\u306b\u7acb\u3064\u3082\u306e\u306b\u3059\u308b\u306b\u306f\u3069\u3046\u3057\u305f\u3089\u826f\u3044\u304b\uff1f<\/strong><\/h2>\n

\u307e\u305a\uff0c\u56fd\u5185\u3067\u306eChoosing Wisely\u00ae\u306e\u8a8d\u77e5\u5ea6\u3092\u4e0a\u3052\u308b\u3053\u3068\u3067\u3042\u308b\uff0e\u5e83\u304f\u77e5\u3089\u308c\u306a\u3051\u308c\u3070\uff0c\u4e16\u306e\u4e2d\u306f\u5909\u308f\u3089\u306a\u3044\uff0e\u30a6\u30a7\u30d6\u30b5\u30a4\u30c8\u3067\u306e\u60c5\u5831\u767a\u4fe1\u306e\u307b\u304b\u5404\u7a2e\u8b1b\u6f14\u4f1a\u304c\u884c\u308f\u308c\u3066\u3044\u308b\u304c\uff0c\u3044\u305a\u308c\u3082pull\u578b\u306e\u60c5\u5831\u63d0\u4f9b\u3067\u3042\u308a\uff0c\u73fe\u72b6\u3067\u306f\uff0c\u3082\u3068\u3082\u3068\u610f\u8b58\u304c\u9ad8\u3044\u4eba\u306b\u3057\u304b\u60c5\u5831\u304c\u5c4a\u304b\u3089\u306a\u3044\uff0e\u8a3a\u7642\u73fe\u5834\u3067\u4e00\u304b\u3089\u8aac\u660e\u3057\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u306e\u3067\u306f\uff0c\u533b\u7642\u8005\u306e\u8ca0\u62c5\u3092\u5897\u3084\u3059\u3070\u304b\u308a\u3067\uff0c\u73fe\u5b9f\u7684\u306b\u306f\u96e3\u3057\u3044\uff0e\u305d\u306e\u305f\u3081\uff0c\u533b\u7642\u8005\u306b\u306f\u3082\u3061\u308d\u3093\u306e\u3053\u3068\uff0c\u4e00\u822c\u5e02\u6c11\u306b\u3082\u6d78\u900f\u3059\u308b\u3088\u3046\u306a\u6226\u7565\u304c\u5fc5\u8981\u3067\u3042\u308b\uff0e<\/p>\n

\u307e\u305f\uff0c\u63a8\u5968\u305d\u306e\u3082\u306e\u304c\uff0c\u8cea\u306e\u9ad8\u3044\u30a8\u30d3\u30c7\u30f3\u30b9\u306b\u57fa\u3065\u3044\u305f\u3082\u306e\u3067\u306a\u304f\u3066\u306f\u306a\u3089\u306a\u3044\uff0eChoosing Wisely\u00ae\u306e\u63a8\u5968\u306f\uff0c\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306e\u63a8\u5968\u3068\u540c\u3058\u3067\u3042\u308a\uff0c\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u30b7\u30b9\u30c6\u30de\u30c6\u30a3\u30c3\u30af\u30ec\u30d3\u30e5\u30fc\u3092\u884c\u3063\u305f\u4e0a\u3067\u4f5c\u6210\u3059\u308b\u306e\u304c\u57fa\u672c\u3067\u3042\u308d\u3046\uff0e\u8cea\u306e\u9ad8\u3044\u30a8\u30d3\u30c7\u30f3\u30b9\u306b\u3088\u308b\u63a8\u5968\u3092\u4f5c\u6210\u3059\u308b\u5fc5\u8981\u304c\u3042\u308a\uff0c\u7c73\u56fd\u306b\u304a\u3051\u308b\u4e88\u9632\u533b\u7642\u306e\u63a8\u5968\u3092\u63d0\u793a\u3057\u3066\u3044\u308bUSPSTF8<\/sup>\u306a\u3069\u304c\u305d\u306e\u53c2\u8003\u306b\u306a\u308b\uff0e<\/p>\n

\u305d\u3057\u3066\uff0c\u308f\u304c\u56fd\u306e\u51fa\u6765\u9ad8\u6255\u3044\u5b9a\u306e\u8a3a\u7642\u5831\u916c\u4f53\u7cfb\u3082\u8003\u3048\u76f4\u3059\u5fc5\u8981\u304c\u3042\u308b\uff0e\u5165\u9662\u8a3a\u7642\u3067\u306f\u5305\u62ec\u533b\u7642\u304c\u5c0e\u5165\u3055\u308c\u3066\u304a\u308a\uff0c\u7121\u99c4\u306a\u533b\u7642\u3092\u7701\u304f\u65b9\u5411\u3067\u30a4\u30f3\u30bb\u30f3\u30c6\u30a3\u30f4\u304c\u50cd\u304f\u304c\uff0c\u5916\u6765\u8a3a\u7642\u3067\u306f\uff0c\u691c\u67fb\u3082\u6cbb\u7642\u3082\u3084\u308c\u3070\u3084\u308b\u307b\u3069\u53ce\u76ca\u304c\u4e0a\u304c\u308b\u30b7\u30b9\u30c6\u30e0\u306b\u306a\u3063\u3066\u3044\u308b\uff0e\u5916\u6765\u8a3a\u7642\u3082\u5305\u62ec\u533b\u7642\u306b\u3059\u308b\u304b\uff0c\u51fa\u6765\u9ad8\u6255\u3044\u3067\u3082\uff0c\u52b9\u679c\u306e\u5927\u304d\u3055\u306b\u3088\u3063\u3066\u5831\u916c\u984d\u3092\u6c7a\u3081\u308boutcome-oriented\u306e\u8a3a\u7642\u5831\u916c\u4f53\u7cfb\u3082\u63a8\u9032\u3057\u3066\u3044\u304f\u5fc5\u8981\u304c\u3042\u308b\uff0e<\/p>\n

\u4ee5\u4e0a\uff0c\u672c\u7a3f\u3067\u306fChoosing Wisely\u00ae\u306e\u5f71\u306e\u90e8\u5206\u306b\u7126\u70b9\u3092\u5f53\u3066\u3066\u8ad6\u3058\u3066\u307f\u305f\uff0e\u3088\u308a\u826f\u3044\u533b\u7642\u306e\u666e\u53ca\u306e\u305f\u3081\u306b\u4f55\u304c\u3067\u304d\u308b\u304b\uff0c\u4eca\u5f8c\u3082\u8003\u3048\u3066\u3044\u304d\u305f\u3044\uff0e<\/p>\n

\u6587\u732e<\/p>\n

    \n
  1. Brody H. Medicine’s ethical responsibility for health care reform\uff0dthe top five list. N Engl J Med 2010; 362\uff084\uff09:283-5.<\/li>\n
  2. Choosing Wisely Japan. https:\/\/choosingwisely.jp<\/li>\n
  3. Admon AJ and Cooke CR. Will Choosing Wisely\u00ae improve quality and lower costs of care for patients with critical illness? Ann Am Thorac Soc. 2014 Jun;11(5):823-72.<\/li>\n
  4. Atkinson P et al. CJEM Debate Series: #ChoosingWisely – The Choosing Wisely campaign will not impact physician behaviour and choices. CJEM. 2018 Mar;20(2):170-5.<\/li>\n
  5. Admon AJ et al. Appraising the Evidence Supporting Choosing Wisely\u00ae Recommendations. J Hosp Med. 2018 Apr 25.<\/li>\n
  6. AGREE II. http:\/\/www.agreetrust.org\/.<\/li>\n
  7. \u5357\u90f7\u6804\u79c0\uff0c\u4ed6\uff0e\u65e5\u672c\u306e\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306e\u8cea\u306f\u4f4e\u304f\uff0c\u6539\u5584\u306e\u4f59\u5730\u304c\u5927\u304d\u3044\uff0e\u7b2c5\u56de\u65e5\u672c\u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u9023\u5408\u5b66\u4f1a\u5b66\u8853\u5927\u4f1a\uff0c\u5ca1\u5c71\uff0c2014.<\/li>\n
  8. U.S. Preventive Services Task Force. https:\/\/www.uspreventiveservicestaskforce.org\/.<\/li>\n<\/ol>\n

    \u6ce81\uff09\u672c\u30a8\u30f3\u30c8\u30ea\u30fc\u306f\uff0c\u533b\u6b6f\u85ac\u51fa\u7248\u682a\u5f0f\u4f1a\u793e\u306e\u9031\u520a\u300e\u533b\u5b66\u306e\u3042\u3086\u307f\u300f266\u5dfb8\u53f7\uff082018\u5e748\u670825\u65e5\u767a\u884c\uff09\uff08http:\/\/www.ishiyaku.co.jp\/magazines\/ayumi\/AyumiBookDetail.aspx?BC=926608<\/a>\uff09\u306b\u5bc4\u7a3f\u3057\u305f\u300c\u9023\u8f09Choosing Wisely\u00ae\u30ad\u30e3\u30f3\u30da\u30fc\u30f3\u300d\u306e\u540c\u540d\u30bf\u30a4\u30c8\u30eb\u306e\u30b3\u30e9\u30e0\u3092\u52a0\u7b46\u4fee\u6b63\u3057\u305f\u3082\u306e\u3067\u3042\u308b\uff0e\u540c\u793e\u306e\u8a31\u8afe\u3092\u5f97\u3066\u63b2\u8f09\u3057\u3066\u3044\u308b\uff0e<\/p>\n

    \"P9145334\"
    \n\uff08    \u5927\u5009\u5c71\u30b8\u30e3\u30f3\u30d7\u7af6\u6280\u5834<\/a>\u306b\u3066\uff0c2013\/9\/14\u64ae\u5f71\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

    2010\u5e74\uff0cInstitute for the Medical Humanities\u6240\u9577\u3067\u30c6\u30ad\u30b5\u30b9\u5927\u5b66\u5bb6\u5ead\u533b\u5b66\u79d1\u6559\u6388\u306eBrody H\u6c0f\u304c\uff0cN Engl J Med\u8a8c\u306b\u300cMedicine’s ethical r […]<\/p>\n","protected":false},"author":1,"featured_media":46,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"vkexunit_cta_each_option":"","footnotes":""},"categories":[2],"tags":[],"class_list":["post-145","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ebm"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/spell.umin.jp\/thespellblog\/wp-content\/uploads\/2018\/05\/thespellblogtop.png?fit=500%2C263&ssl=1","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p9TdsT-2l","jetpack_likes_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/spell.umin.jp\/thespellblog\/index.php?rest_route=\/wp\/v2\/posts\/145","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/spell.umin.jp\/thespellblog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/spell.umin.jp\/thespellblog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/spell.umin.jp\/thespellblog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/spell.umin.jp\/thespellblog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=145"}],"version-history":[{"count":3,"href":"https:\/\/spell.umin.jp\/thespellblog\/index.php?rest_route=\/wp\/v2\/posts\/145\/revisions"}],"predecessor-version":[{"id":163,"href":"https:\/\/spell.umin.jp\/thespellblog\/index.php?rest_route=\/wp\/v2\/posts\/145\/revisions\/163"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/spell.umin.jp\/thespellblog\/index.php?rest_route=\/wp\/v2\/media\/46"}],"wp:attachment":[{"href":"https:\/\/spell.umin.jp\/thespellblog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=145"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/spell.umin.jp\/thespellblog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=145"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/spell.umin.jp\/thespellblog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=145"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}