在综合医疗保健系统中管理,利用和早产产的结果
Darios Getahun1,2, David A Sacks3, Jiaxiao Shi1
1Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California.
American journal of perinatology
|May 7, 2024
概括
胎儿纤维生素 (fFN) 测试可以准确预测自发早产 (sPTB) 和相关并发症. 负面的fFN结果与不良结果的几率较低有关,并且fFN测试可以节省成本.
科学领域:
- 孕产妇和胎儿的医学
- 新生儿结局的结果.
- 医疗保健经济学 医疗保健经济学
背景情况:
- 自发早产 (sPTB) 对新生儿构成重大风险,包括呼吸应急综合征 (RDS) 和NICU入院.
- 胎儿纤维菌素 (fFN) 测试和跨阴道超声波 (TVUS) 宫长度 (CL) 测量用于预测早产 (PTL) 妇女的sPTB.
- 评估这些诊断工具的预测准确性和成本效益对于临床决策至关重要.
研究的目的:
- 评估fFN测试和/或TVUS CL测量与sPTB的预测之间的关联.
- 评估fFN和TVUS对新生儿结局 (如RDS和NICU入院) 的预测价值.
- 为了比较与fFN测试相关的医疗保健费用与管理PTL时的TVUS.
主要方法:
- 一项回顾性队列研究使用来自南加利福尼亚州凯泽永久医院 (2009-2020) 的电子健康记录进行.
- 通过fFN和/或TVUS评估定义的PTL评估的怀孕被使用诊断代码和自然语言处理识别出来.
- 多变量后勤回归分析了fFN/TVUS结果与围产期结局之间的关联,包括sPTB,RDS和NICU入院.
主要成果:
- 阳性fFN测试与增加sPTB (adj.OR:2.95),RDS (adj.OR:2.34) 和NICU入院 (adj.OR:2.24) 的几率显著相关.
- 负的fFN测试显示,sPTB (adj.OR:0.75),RDS (adj.OR:0.67) 和NICU入院 (adj.OR:0.74) 的几率下降.
- 在阳性fFN病例中,sPTB概率与CL相反相关,单靠fFN测试就产生了最低的医疗保健成本.
结论:
- fFN测试是sPTB,RDS和NICU入院的有价值预测指标,正结果表明更高的风险,负结果表明更低的风险.
- 在积极的fFN病例中,sPTB和CL之间的反向关系突显了联合评估的重要性.
- 与TVUS相比,fFN的测试表明了潜在的成本节约,这表明它在优化PTL管理资源配置方面具有实用性.
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