对绝经后出血的诊断评估的及时性:使用索赔数据的回顾性队列研究
Xiao Xu1,2, Ling Chen3, Marcella Nunez-Smith4
1Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States of America.
PloS one
|September 8, 2023
概括
许多患者经历了更年期后出血 (PMB) 的延迟诊断评估. 保险类型,年龄和并发症显著影响PMB护理的及时性.
科学领域:
- 妇科 妇科医生 妇科
- 医疗保健服务研究 医疗服务研究
- 流行病学 流行病学
背景情况:
- 绝经后出血 (PMB) 是一个常见的妇科症状.
- 虽然PMB可以表明子宫癌,但大多数病例都有良性原因.
- 之前关于PMB诊断评估及时性的研究主要集中在癌症患者身上.
研究的目的:
- 在没有妇科癌症的患者中调查绝经后出血 (PMB) 的诊断评估的及时性.
- 确定影响PMB诊断程序延迟的因素.
主要方法:
- 利用MarketScan研究数据库 (2008-2019) 识别499,176名PMB患者没有癌症诊断.
- 从PMB报告到第一个诊断程序的时间.
- 采用考克斯的比例风险模型来分析患者特征和及时性之间的关联,按保险类型分层 (商业 vs 医疗补助).
主要成果:
- 54.3%的患者在同一天接受了诊断程序; 86.6%在12个月内.
- 与商业保险患者相比,Medicaid患者的发病率明显较低 (39.4%在同一天发病,77.1%在12个月内发病) (55.7%在同一天发病,87.4%在12个月内发病).
- 诸如老年,并发症,保险类型和种族/地理位置等因素影响了诊断的及时性.
结论:
- 相当数量的患者在诊断性评估中面临延迟,因为绝经后出血.
- 临床因素 (如并发症) 和非临床因素 (如保险类型,社会经济地位) 都会影响PMB评估的及时性.
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