远程医疗：高危妊娠的成本效益管理

Telemedicine: cost-effective management of high-risk pregnancy.

作者信息

Morrison J, Bergauer N K, Jacques D, Coleman S K, Stanziano G J

机构信息

Dept. of Ob/Gyn, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216, USA.

出版信息

Manag Care. 2001 Nov;10(11):42-6, 48-9.

PMID:11761593

Abstract

PURPOSE

To evaluate the cost-effectiveness of telemedicine services in patients diagnosed with preterm labor (PTL).

DESIGN

Women hospitalized with a diagnosis of PTL during a 3-year study period were identified within a health maintenance organization.

INCLUSION CRITERIA

singleton gestation, stabilized after tocolysis and discharged from the hospital, and participation in the HMO's preterm-birth prevention program. After a PTL diagnosis, telemedicine services (home uterine activity monitoring with daily telephonic nursing contact) were authorized by the payer. The decision to prescribe telemedicine services was made by each patient's individual physician. Two groups of patients were identified: those who received telemedicine services (telemedicine group), and those who received standard care without the adjunctive outpatient service (control group).

METHODS

Descriptive and statistical methods were used to compare maternal demographics, pregnancy outcome, antepartum hospitalization, delivery, nursery, and outpatient services.

PRINCIPAL FINDINGS

One hundred women were identified: 60 in the telemedicine group and 40 in the control group. Gestational age at diagnosis of PTL was similar at 29.4 +/- 3.8 weeks, telemedicine group vs. 28.0 +/- 7.4 weeks, control group (P = 0.252). The telemedicine group had a significantly later mean gestational age at delivery (38.2 +/- 1.4 vs. 35.3 +/- 3.8), higher mean birth weight (3224 +/- 588 vs. 2554 +/- 911), fewer mean total nursery days (2.4 +/- 1.8 vs. 14.9 +/- 26.4), and less frequent admission to the neonatal intensive care unit (6.7 percent vs. 40 percent) than the control group (all P < 0.005). The total mean cost per pregnancy was $7,225 for the telemedicine group and $21,684 for the control group. This represented average savings of $14,459 per pregnancy using telemedicine services.

CONCLUSION

Following an episode of PTL, use of telemedicine services can be a cost-effective tool to improve pregnancy outcome.

摘要

目的

评估远程医疗服务对诊断为早产（PTL）患者的成本效益。

设计

在一家健康维护组织中，确定在3年研究期间因诊断为PTL而住院的女性。

纳入标准

单胎妊娠，经宫缩抑制剂治疗后病情稳定并出院，且参与健康维护组织的早产预防计划。在诊断为PTL后，支付方批准了远程医疗服务（通过每日电话护理联系进行家庭子宫活动监测）。是否开具远程医疗服务的决定由每位患者的主治医生做出。确定了两组患者：接受远程医疗服务的患者（远程医疗组）和接受无附加门诊服务的标准护理的患者（对照组）。

方法

使用描述性和统计方法比较产妇人口统计学、妊娠结局、产前住院、分娩、新生儿护理和门诊服务情况。

主要发现

共确定了100名女性：远程医疗组60名，对照组40名。PTL诊断时的孕周相似，远程医疗组为29.4±3.8周，对照组为28.0±7.4周（P = 0.252）。远程医疗组的平均分娩孕周明显更晚（38.2±1.4 vs. 35.3±3.8），平均出生体重更高（3224±588 vs. 2554±911），平均新生儿护理总天数更少（2.4±1.8 vs. 14.9±26.4），新生儿重症监护病房入院频率更低（6.7% vs. 40%），均低于对照组（所有P < 0.005）。远程医疗组每次妊娠的总平均成本为7225美元，对照组为21684美元。这意味着使用远程医疗服务每次妊娠平均节省14459美元。