探討使用健保醫療資訊雲端查詢系統與重複醫學影像檢查的關係

研究背景：隨著醫療費用逐年攀升，其中檢查費用占率高達四分之一，又以電腦斷層掃描與核磁共振檢查費用占大宗，若能避免不必要的重複檢查有助於提升醫療資源使用效率。研究目的：探討健保醫療資訊雲端查詢系統與90日內重複執行電腦斷層掃描或核磁共振檢查的關係。研究方法：本研究為回溯型多年期橫斷研究，使用健保署「全民健康保險保險人資訊整合應用服務中心」資料庫進行次級資料分析，納入2017年1月1日至2019年12月31日所有門急診就醫資料、且過去90日內曾有執行電腦斷層掃描或核磁共振檢查者，作為本研究對象，若當次門急診就醫有執行電腦斷層掃描或核磁共振檢查者，則視為「重複影像檢查」，使用羅吉斯迴歸分析，在控制病患特性、醫師特性、院所特性及時間趨勢後，探討健保醫療資訊雲端查詢系統與90日內重複執行電腦斷層掃描或核磁共振檢查的關係。研究結果：2017-2019年「門診病患執行電腦斷層掃描檢查」、「急診病患執行電腦斷層掃描檢查」、「門診病患執行核磁共振檢查」、「急診病患執行核磁共振檢查」重複率分別為0.70%、7.11%、0.42%、0.42%。在控制病患特性、醫師特性、院所特性及時間趨勢後，病患在門診就醫的情況下，相較於醫師完全沒有查詢者，僅預先批次下載檢查報告者(OR=1.032-1.156)、透過線上查詢檢查報告但無調閱影像者(OR=1.305-1.427)及有調閱影像者(OR=2.732-3.522)，均會增加重複執行電腦斷層掃描或核磁共振檢查的機會；但在急診就醫的情況下，相較於醫師完全沒有查詢者，僅預先批次下載檢查報告者(OR=1.343)會增加重複執行核磁共振檢查的機會，而透過線上查詢檢查報告但無調閱影像者(OR=1.237)及有調閱影像者(OR=1.99)，則會增加重複執行電腦斷層掃描檢查的機會。結論：此研究發現在控制病患特性、醫師特性、院所特性及時間趨勢後，健保醫療資訊雲端查詢系統的使用與90日內重複執行電腦斷層掃描或核磁共振檢查間呈現顯著正相關，可能與政策介入有關，醫師若在開立前有調閱過去的檢查報告或影像，則可避免重複檢查費用遭致核扣。

關鍵字

健保醫療資訊雲端查詢系統；醫療資訊交換系統；重複檢查；電腦斷層掃描；核磁共振

並列摘要

Background：Examination expenses account for up to a quarter of total medical expenses, which have increased year after year. The cost of computed tomography (CT) and magnetic resonance imaging (MRI) are among the most costly. Avoiding unnecessarily duplicated medical imaging procedures will help to improve the efficiency of medical resources. Objective：To explore the association between the use of National Health Insurance’s MediCloud System and duplicate medical imaging procedures. Methods：This study was a retrospective multi-year cross-sectional study using a nationwide population-based data set from Taiwan’s National Health Insurance system. Patients who utilized outpatient and emergency services between 2017 and 2019 were included, and patients who had gotten a CT or MRI in the prior 90 days were also identified. A CT or MRI of the same part of the body that had been ordered for a patient during previous outpatient or emergency services was regarded as a "repeated medical imaging procedure". Using Logistic regression analysis, the association between the use of National Health Insurance’s MediCloud System and duplicate medical imaging procedures was explored after controlling patient characteristics, physician characteristics, hospital characteristics, and time trends. Results：Between 2017 to 2019, patients were divided into "outpatient had gotten CT in the past'', "emergency had gotten CT in the past'', "outpatient had gotten MRI in the past'', and "emergency had gotten MRI in the past''. The repeat rates were 0.70%, 7.11%, 0.42%, and 0.42%, respectively. After controlling patient characteristics, physician characteristics, hospital characteristics, and time trends, when patients utilized outpatient services, the odds of a repeated CT or MRI increased for patients who had downloaded medical imaging reports in advance in batches (OR=1.032-1.156), for patients who had checked medical imaging reports online but did not have access to images (OR=1.305-1.427), and for patients who had accessed medical images (OR=2.732-3.522), compared with patients who had not inquired about a patient’s medical history in the National Health Insurance’s MediCloud System; however, when patients utilized emergency services, the odds of a repeated MRI increased for patients who had downloaded medical imaging reports in advance in batches (OR=1.343), and the odds of a repeated CT increased for patients who had checked medical imaging reports online but did not have access to images (OR=1.273), and for patients who had accessed medical images (OR=1.99), compared with patients who had not inquired about a patient’s medical history in the National Health Insurance’s MediCloud System. Conclusion：This study found that after controlling patient characteristics, physician characteristics, hospital characteristics, and time trends, the use of the National Health Insurance's MediCloud System was significantly and positively correlated with repeated CT or MRI within 90 days, which may be related to the impact of current policies. If a doctor reviews a patient’s past medical imaging reports or images before placing an order, claiming expenses by the “third-party insurer” as a result of duplicate medical imaging procedures can be avoided.

並列關鍵字

NHI-MediCloud System ； health information exchange system ； duplicate medical imaging procedures ； computer tomography ； magnetic resonance imaging

參考文獻

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探討使用健保醫療資訊雲端查詢系統與重複醫學影像檢查的關係

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