Timeliness of diagnostic evaluation for postmenopausal bleeding: A retrospective cohort study using claims data.
Timeliness of diagnostic evaluation for postmenopausal bleeding: A retrospective cohort study using claims data.
复制标题
DOI：
10.1371/journal.pone.0289692
复制
发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
绝经后出血（PMB）是一种常见的妇科疾病。虽然它可能是子宫癌的征兆，但大多数患者的病因是良性的。然而，对PMB诊断评价质量的研究仅限于癌症患者。为了扩展这项研究，我们检查了良性疾病患者中PMB诊断评估的及时性。使用2008 - 2019年MarketScan研究数据库，我们确定了499176例患者（456741例有商业保险，42435例有医疗补助保险），他们患有PMB，但没有妇科癌症。对于每例患者，我们测量了从他们的PMB报告到他们首次诊断程序的时间。使用考克斯比例风险模型（针对总体样本，然后按保险类型分层）检查患者特征与首次诊断程序时间之间的相关性。总体而言，54.3%的患者在报告PMB当天接受了诊断程序，86.6%的患者在报告PMB后12个月内接受了诊断程序。医疗补助患者的这一比例分别为39.4%和77.1%，而商业保险患者的这一比例分别为55.7%和87.4%（两者p <0.001）。医疗补助患者在任何给定时间点接受诊断程序的比率比商业保险患者低18%（调整后的风险比= 0.82，95% CI：0.81 - 0.83）。同时，年龄较大和非妇科合并症与较低的比率相关，而伴随妇科疾病和近期使用预防性护理与接受诊断程序的较高比率相关。按保险类型分层的分析确定了延迟诊断程序的其他风险因素（例如，对于商业保险患者，非大城市与大城市位置，对于医疗补助患者，黑人与白色种族）。相当大比例的患者没有及时接受PMB的诊断评估。临床和非临床因素都可能影响评价的及时性。
Postmenopausal bleeding (PMB) is a common gynecologic condition. Although it can be a sign of uterine cancer, most patients have benign etiology. However, research on quality of diagnostic evaluation for PMB has been limited to cancer patients. To extend this research, we examined the timeliness of diagnostic evaluation for PMB among patients with benign conditions. Using the 2008–2019 MarketScan Research Databases, we identified 499176 patients (456741 with commercial insurance and 42435 with Medicaid insurance) who presented with PMB but did not have gynecologic cancer. For each patient, we measured the time from their PMB reporting to the date of their first diagnostic procedure. The association between patient characteristics and time to first diagnostic procedure was examined using Cox proportional hazards models (for the overall sample and then stratified by insurance type). Overall, 54.3% of patients received a diagnostic procedure on the same day when they reported PMB and 86.6% received a diagnostic procedure within 12 months after reporting PMB. These percentages were 39.4% and 77.1%, respectively, for Medicaid patients, compared to 55.7% and 87.4%, respectively, for commercially insured patients (p<0.001 for both). Medicaid patients had an 18% lower rate of receiving a diagnostic procedure at any given time point than commercially insured patients (adjusted hazard ratio = 0.82, 95% CI: 0.81–0.83). Meanwhile, older age and non-gynecologic comorbidities were associated with a lower rate whereas concomitant gynecologic conditions and recent use of preventive care were associated with a higher rate of receiving diagnostic procedures. Analysis stratified by insurance type identified additional risk factors for delayed diagnostic procedures (e.g., non-metropolitan versus metropolitan location for commercially insured patients and Black versus White race for Medicaid patients). A sizable proportion of patients did not receive prompt diagnostic evaluation for PMB. Both clinical and non-clinical factors could affect timeliness of evaluation.
登录
查看更多内容
DOI：
10.1016/j.ogc.2019.07.001
发表时间：
2019-12-01
影响因子：
3.2
作者：
Khafaga, Ashraf;Goldstein, Steven R.
通讯作者：
Goldstein, Steven R.
DOI：
10.1158/1940-6207.capr-21-0121
发表时间：
2021-12
期刊：
Cancer prevention research (Philadelphia, Pa.)
影响因子：
--
作者：
Karia PS;Joshu CE;Visvanathan K
通讯作者：
Visvanathan K
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
9.8
作者：
Doll KM;Howard AG;Stürmer T;Carey T;Nicholson WK;Carey E;Myers E;Nerenz D;Robinson WR
通讯作者：
Robinson WR
影响因子：
7.2
作者：
通讯作者：
--