Dalton Vanessa K, Harris Lisa H, Clark Sarah J, Cohn Lisa, Guire Ken, Fendrick A Mark
Department of Obstetrics and Gynecology, University of Michigan Medical School, 1500 E. Medical Center Drive, L4000, Women's Hospital, Ann Arbor, MI 48109, USA.
J Womens Health (Larchmt). 2009 Jun;18(6):787-93. doi: 10.1089/jwh.2008.1091.
We describe current treatment patterns for early pregnancy failure (EPF) among women enrolled in two Michigan health plans.
We conducted a retrospective review of EPF treatment among Michigan Medicaid enrollees between January 1, 2001, and December 31, 2004, and enrollees of a university-affiliated health plan between January 1, 2001, and December 31, 2005. Episodes were identified by the presence of a diagnostic code for EPF. Surgical treatment was distinguished from nonsurgical management using procedure codes. Facility charges, procedure, and place of service codes were used to determine whether a procedure was done in an office as opposed to an operating room. Cases without a claim for surgical uterine evacuation were examined for a misoprostol pharmacy claim and, if present, were classified as medical management. Cases without a procedure or pharmacy claim were classified as expectant management.
Respectively, we identified 21,311 and 1,493 episodes of EPF in the Medicaid and university-affiliated health plan databases, respectively. Women enrolled in Medicaid were more likely to be treated with surgery than were enrollees of the university-affiliated health plan (35.3 vs. 18.0%, respectively, p < 0.000). Among Medicaid enrollees, only 0.5% of surgical evacuations occurred in the office, but office procedures were common among enrollees of the university-affiliated health plan (30.5%, p < 0.000). The proportion of cases managed with misoprostol was <1% in both groups. Caucasian race and age were both associated with having a surgical uterine evacuation (p < 0.001).
EPF is primarily being treated with expectant management or surgical evacuation in an operating room and may not reflect evidence-based practices or patient preferences.
我们描述了密歇根州两个健康计划中登记女性早期妊娠失败（EPF）的当前治疗模式。
我们对2001年1月1日至2004年12月31日期间密歇根医疗补助计划的参保者以及2001年1月1日至2005年12月31日期间大学附属健康计划的参保者的EPF治疗情况进行了回顾性研究。通过EPF诊断代码识别病例。使用手术代码区分手术治疗和非手术管理。利用医疗机构收费、手术和服务地点代码来确定手术是在办公室还是手术室进行。对没有手术清宫索赔的病例检查米索前列醇药房索赔情况，如有则归类为药物治疗。没有手术或药房索赔的病例归类为期待治疗。
我们分别在医疗补助计划和大学附属健康计划数据库中确定了21311例和1493例EPF病例。参加医疗补助计划的女性比参加大学附属健康计划的女性更有可能接受手术治疗（分别为35.3%和18.0%，p<0.000）。在医疗补助计划参保者中，只有0.5%的手术清宫在办公室进行，但办公室手术在大学附属健康计划参保者中很常见（30.5%，p<0.000）。两组中使用米索前列醇治疗的病例比例均<1%。白种人和年龄均与手术清宫有关（p<0.001）。
EPF主要采用期待治疗或在手术室进行手术清宫，可能未反映循证实践或患者偏好。
