Fragmentation of Care in Ectopic Pregnancy.
Fragmentation of Care in Ectopic Pregnancy.
复制标题
宫外孕护理的分散化。
DOI：
10.1007/s10995-016-1979-z
复制
发表时间：
2016
影响因子：
2.3
通讯作者：
Lindau,StacyT
中科院分区：
文献类型：
--
作者：
Stulberg,DebraB;Dahlquist,Irma;Jarosch,Christina;Lindau,StacyT
目的异位妊娠是孕产妇发病和死亡的重要原因。经历零散护理的妇女可能会在诊断和治疗方面遭受不必要的延误。基于异位妊娠的情况下，在临床实践中观察到的，提出了我们的关注碎片化的护理，我们设计了一项探索性研究，以描述的数量，特点和结果的碎片化护理异位妊娠患者在一个城市的学术hospital.MethodsChart审查与描述性统计。片段护理被定义为一个病人正在评估可能的异位妊娠和转移，转介，或出院前接受护理在研究institution.ResultsOf 191名妇女看到可能或明确的异位妊娠在研究期间，42（22%）符合研究定义的片段护理。该研究的动力不足，无法观察到各组之间的统计学显著差异，但我们发现了令人担忧的非显著趋势：与非分散护理的患者相比，分散护理的患者更有可能成为医疗补助接受者（65.9 vs. 58.8%）并经历并发症（23.8 vs. 18.1%）。大多数患者（n = 37）在转移前未接受任何可识别的治疗，并且到达研究医院时未与外部提供者（n = 34）进行沟通。9例患者（21%）出现异位妊娠破裂。我们在我们的研究中观察到的碎片可能有助于以前确定的社会经济差异异位妊娠outcomes.ConclusionIf未来的研究证实了这些发现，健康信息交流和区域协调的护理可能是降低孕产妇死亡率的重要策略。
ObjectivesEctopic pregnancy is an important cause of maternal morbidity and mortality. Women who experience fragmented care may undergo unnecessary delays to diagnosis and treatment. Based on ectopic pregnancy cases observed in clinical practice that raised our concern about fragmentation of care, we designed an exploratory study to describe the number, characteristics, and outcomes of fragmented care among patients with ectopic pregnancy at one urban academic hospital.MethodsChart review with descriptive statistics. Fragmented care was defined as a patient being evaluated at an outside facility for possible ectopic pregnancy and transferred, referred, or discharged before receiving care at the study institution.ResultsOf 191 women seen for possible or definite ectopic pregnancy during the study period, 42 (22 %) met the study definition of fragmented care. The study was under-powered to observe statistically significant differences across groups, but we found concerning, non-significant trends: patients with fragmented care were more likely to be Medicaid recipients (65.9 vs. 58.8 %) and to experience a complication (23.8 vs. 18.1 %) compared to those with non-fragmented care. Most patients (n = 37) received no identifiable treatment prior to transfer and arrived to the study hospital with no communication to the receiving hospital from the outside provider (n = 34). Nine patients (21 %) presented with ruptured ectopic pregnancies. The fragmentation we observed in our study may contribute to previously identified socio-economic disparities in ectopic pregnancy outcomes.ConclusionIf future research confirms these findings, health information exchanges and regional coordination of care may be important strategies for reducing maternal mortality.