醫療處置安排的差異性是否會影響治療結果:以子宮外孕為例

背景: 醫療處置安排的差異是普遍存在於醫療提供者的現象，不同的醫療處置安排所耗費的醫療資源與費用自然不同，而醫療醫療處置安排的差異性是否會影響醫療的結果與照護品質，是一個值得加以探討的議題。目的: 本研究主要以早期未破裂的子宮外孕，施行methotrexate藥物保守治療為例，探討比較於門診注射治療及於住院治療兩種醫療處置安排上的差異，對臨床治療結果與醫療資源耗用上的影響，並分析對醫療照護品質的影響。方法: 本研究使用國家衛生研究院之全民健康保險研究資料庫，進行回溯性的次級資料庫分析，選取2001年至2011年間，被診斷為子宮外孕並以methotrexate進行保守性內科治療的個案，分為門診與住院治療兩組，針對治療結果以60日內是否因治療失敗須接受手術及總醫療耗用做測量，並以5日內急診/(再)住院做為照護品質之指標等方面做研究，並使用線性迴歸模型、負二項迴歸模型與邏輯迴歸模型進行分析。結果: 研究發現76% (275/362)無症狀的早期子宮外孕患者，進行保守性MTX藥物治療時，仍是以於門診治療為主。住院治療所耗用的醫療費用明顯較高(28461 vs. 2694 NTD)，但治療後5日內非預期急診利用與再住院率較門診治療為低(3.4% vs. 12.4%)。不同院所層級別之照護品質並無明顯差異。結論:兩種醫療處置安排之成功率相當，醫療處置安排之差異性並不影響療效;而住院治療對醫療資源的耗用較門診為高，但因照護品質的提升，減少了非預期性的急診利用或再住院。在照護品質相當的前提下，接受非侵入性之保守療法時，於較低的層級別院所治療，非但不影響治療療效，也不影響醫療照護品質。

關鍵字

醫療處置安排；子宮外孕；保守性療法；醫療資源耗用；照護品質

並列摘要

Background: Practice pattern variation commonly exists among medical suppliers. Different treatment arrangements result in different medical consumption. It’s an important issue if practice pattern variation affects the outcome of treatment and quality of care (QoC). Objective: The study included subjects diagnosed of un-ruptured ectopic pregnancy undergoing medical management with methotrexate. The purpose was to compare the treatment outcome and medical consumption between two arrangement differences, treatment at outpatient clinics or admission. The quality of care was evaluated as well. Methods: The study was a secondary data research using National Health Insurance Research Databases in 2001-2011. Subjects diagnosed as un-ruptured ectopic pregnancy were classified into two groups (treatment at clinics or admission). Treatment outcome and medical consumption were evaluated. QoC care was evaluated if subjects had emergent department visit or re-admission within 5 days after treatment. The analysis model used in the study included linear regression, negative binomial regression model and logistic regression model. Results: 76% of subjects were treated at OPD. The medical consumption was higher in the group which treated at admission than those at clinics (28461 vs. 2694 NTD) but the risk of emergent visit or readmission within 5 days was lower (3.4% vs. 12.4%). The quality of care revealed no difference among different level of institution. Conclusion: The success rate between the two groups was similar. Practice pattern variation didn’t affect treatment outcome but QoC. During conservative management, different level of institution neither affects the treatment outcome nor QoC.