探討低價值醫療利用之相關因素－以高階影像檢查為例

目的：低價值醫療在臨床照護帶來極小好處且可能造成醫源性傷害，目前全球醫療體系與國內醫療機構皆在面對此項艱鉅挑戰。方法：透過2010－2014年衛生福利資料科學中心全民健康保險資料庫檢視「非複雜性頭痛開立低價值頭部影像檢查」、「暈厥開立低價值頭部影像檢查」及「簡單性暈厥開立低價值頸動脈超音波檢查」三項低價值影像檢查利用情形，使用多階層羅吉斯回歸探討在控制醫療機構及病人特質後，低價值影像利用的相關因素。結果：低價值醫療利用率分別為8.98%、14.08%及5.80%。病人的看診醫師影像費用佔所得越高（OR：1.342－4.690）、男性（簡單性暈厥開立低價值頸動脈超音波檢查OR=0.825）、年齡較小（OR：1.198－1.410）及急診醫學科（OR：2.746－4.127，簡單性暈厥開立低價值頸動脈超音波檢查除外）較容易開立低價值影像檢查。結論：本研究發現低價值醫療的利用可能與財務誘因相關，亦凸顯了需要針對醫療服務提供者進行介入干預的重要性。

關鍵字

低價值醫療；醫療適當性；電腦斷層；核磁共振

並列摘要

Objectives: A daunting challenge in the management of health care systems is dealing with low-value care (i.e., care of limited benefit), which can actually cause iatrogenic harm to patients. Methods: This population-based study on low-value care utilization was based on data from the Taiwan National Health Insurance (NHI) database from 2010-2014. We defined the following three types of imaging tests as low-value: head imaging for uncomplicated headache, head imaging for the evaluation of syncope, and carotid ultrasound imaging for simple syncope. Multilevel logistic regression was used to identify physician characteristics associated with the use of low-value imaging tests after controlling for hospital and patient characteristics. Results: The utilization rates of the three imaging tests were as follows: 8.98% for head imaging for uncomplicated headache, 14.08% for head imaging for the evaluation of syncope, and 5.80% for carotid ultrasound imaging for simple syncope. After we controlled for patient and hospital factors, the proportion of physician charges for advanced imaging in annual reimbursement (odds ratio [OR]: 1.342-4.690), sex (carotid ultrasound imaging for simple syncope; OR: 0.825), age (OR: 1.198-1.410), and emergency department (OR: 2.746-4.127, except for carotid ultrasound imaging for simple syncope)were positively associated with the use of low-value imaging tests. Conclusions: Our findings indicated that when patient and hospital characteristics are controlled for, the utilization of low-value care by physicians may be driven by financial incentives. This study elucidates critical problems regarding the need for interventions to mediate the use of low-value care.

並列關鍵字

Low-value care ； appropriate care ； Computed tomography ； Magnetic resonance imaging

參考文獻

吳潔人、吳怡玟、郭年真（2018）‧低價值醫療之探討‧台灣公共衛生雜誌，37 (6)，602-613。 https://doi.org/10.6288/tjph.201812_37(6).107088

劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義（2006）‧台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究‧健康管理學刊，4(1)，1-22。 https://doi.org/10.29805/JHM.200606.0001

Bouck, Z., Ferguson, J., Ivers, N. M., Kerr, E. A., Shojania, K. G., Kim, M., Cram, P., Pendrith, C., Mecredy, G. C., Glazier, R. H., Tepper, J., Austin, P. C., Martin, D., Levinson, W., & Bhatia, R. S. (2018). Physician characteristics associated with ordering 4 low-value screening tests in primary care. JAMA Network Open, 1(6), e183506. https://doi.org/10.1001/jamanetworkopen.2018.3506

Brownlee, S., Chalkidou, K., Doust, J., Elshaug, A. G., Glasziou, P., Heath, I., Nagpal, S., Saini, V., Srivastava, D., Chalmers, K., & Korenstein, D. (2017). Evidence for overuse of medical services around the world. The Lancet, 390(10090), 156-168. https://doi.org/10.1016/S0140-6736(16)32585-5

Chambers, J. D., Salem, M. N., D’Cruz, B. N., Subedi, P., Kamal-Bahl, S. J., & Neumann, P. J. (2017). A Review of Empirical Analyses of Disinvestment Initiatives. Value Health, 20(7), 909-918. https://doi.org/10.1016/j.jval.2017.03.015

國際替代計量

探討低價值醫療利用之相關因素－以高階影像檢查為例

全文下載

主題瀏覽