Evaluating treatment options and patterns of care in early pregnancy failure

描述(由申请人提供)：这项建议的总体目标是进一步发展候选人作为卫生服务研究人员在患者治疗偏好、成本和流产管理领域的技能。拟议的方案使用授课课程、机构资源和强大的指导，提供索赔分析、调查方法和成本效益分析方面的培训。这项建议的目的是了解目前如何处理早孕失败(EPF)，并检查使用患者偏好来 根据成本确定治疗方案。流产管理为研究和鼓励以患者为中心的护理提供了一个理想的机会，因为这是一种常见的事件，而且有几种成功的治疗选择。传统上，妊娠丢失的处理一直是扩张和刮宫(D&C)，最常发生在手术室。这种做法是在EPF患者通常表现为急性出血和/或感染的时候建立的。今天，技术进步使无法存活的妊娠能够在这些症状出现之前很久就被诊断出来。在这种情况下，治疗方案包括期待治疗和药物治疗，以使子宫排出不可行的产品。或者，手术管理可以在基于办公室的环境中进行，这比在手术室进行相同的程序提供了显著的成本节约。现有的少数研究表明，治疗模式不能反映当代临床表现、患者偏好、成本负担或临床结果。我们建议通过对索赔数据的分析，定量描述EPF管理的治疗模式，或通常的护理。(具体目标一)我们在这项建议中提出的初步数据表明，患者的治疗偏好可能不支持常规的手术室管理计划。没有数据描述与治疗模式或选择相关的提供者因素。特定目标II使用基于人群的调查来检查提供者和患者的治疗偏好以及与治疗选择相关的因素。最后，我们使用我们的发现目标I和II来构建一个包括所有治疗选项的假想护理模型。具体目标三将这种由患者偏好驱动的假想护理模式的成本与目标一中定义的常规护理进行了比较。

DESCRIPTION (provided by the applicant): The broad goal of this proposal is to further develop the candidate's skills as a health services researcher in the area of patient treatment preferences, cost and miscarriage management. The proposed program uses didactic course work, institutional resources and strong mentorship to provide training in claims analysis, survey methodology and cost-effectiveness analysis. The purpose of this proposal is to understand how early pregnancy failure (EPF) is currently managed and to examine the effect of using patient preferences to determine treatment on cost. Miscarriage management provides an ideal opportunity to study and encourage patient-centered care because it is a common event and there are several successful treatment options. Traditionally, management of pregnancy loss has been dilation and curettage (D&C), most often occurring in an operating room. This practice was established during a time when patients with EPF typically presented with acute hemorrhage and/or infection. Today, technological advances allow a non-viable pregnancy to be diagnosed well before the onset of these symptoms. Under these conditions, treatment options include expectant management and drug therapy to cause the uterus to expel the non-viable products. Alternatively, surgical management can be done in an office-based setting, which offers significant cost savings over the same procedure performed in an operating room. The few studies available suggest treatment patterns do not reflect contemporary clinical presentations, patient preference, cost burden or clinical outcomes. We propose to quantitatively describe treatment patterns, or usual care, for EPF management by using analysis of claims data. (Specific Aim I) Our preliminary data presented in this proposal demonstrate that patient treatment preferences may not support routine operative room management schemes. There are no data describing provider factors associated with treatment patterns or choices. Specific Aim II uses population based surveys to examine provider and patient treatment preferences and factors associated with treatment choices. Finally, we use our findings Aims I and II to construct a hypothetical care model that includes all treatment options. Specific Aim III compares the cost of this hypothetical care model which is driven by patient preferences with usual care defined in Aim I.