Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea
Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea
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DOI：
10.3346/jkms.2020.35.e54
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发表时间：
2020-02-24
影响因子：
4.5
通讯作者：
Kang, Bo Seung
中科院分区：
文献类型：
--
作者：
Choi, Wook Jin;Ha, Young-Rock;Kang, Bo Seung
床旁超声（POCUS）是一种广泛用于急诊和重症监护领域的有用工具。在韩国，自2017年至2021年，超声波检查的保险范围已根据韩国国民保险覆盖范围的措施逐步扩大，并将持续至2021年。2019年7月，POCUS在急诊和危重症领域的医疗保险实现全覆盖。《国民健康保险法》将POCUS分类为单靶点或多靶点超声检查（STU vs. MTU）。STU扫描是一次对一个器官进行扫描，而MTU包括同时扫描多个器官以确定每个临床情况。根据医生的决定，即使进行诊断超声检查，也可以进行POCUS。但是，健康保险审查和评估处计划监测POCUS和诊断超声检查是否同时和重复开处方的处方状况。此外，只有在创伤、心脏骤停、休克、胸痛和呼吸困难的情况下才允许使用MTU，应由合格的医生进行。虽然医生在开MTU处方时应扫描胸部、心脏和腹部的所有部位，但他们不需要在病历中记录所有发现。因此，需要适当的处方、应用和记录POCUS，以提高患者护理质量，避免不必要的医疗预算支出削减。本文基于2019年7月开始在韩国实施的POCUS全面健康保险，为POCUS提供了背景和临床指导。
Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.