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保险福利和教育对单个急诊科即时超声使用的影响:一项中断时间序列分析。

Impact of Insurance Benefits and Education on Point-of-Care Ultrasound Use in a Single Emergency Department: An Interrupted Time Series Analysis.

机构信息

Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

Department of Emergency Medicine, Graduate School of Kangwon National University, Chuncheon-si 24341, Korea.

出版信息

Medicina (Kaunas). 2022 Feb 1;58(2):217. doi: 10.3390/medicina58020217.

DOI:10.3390/medicina58020217
PMID:35208540
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8878237/
Abstract

: Point-of-care ultrasound (POCUS) is a useful tool that helps clinicians properly treat patients in emergency department (ED). This study aimed to evaluate the impact of specific interventions on the use of POCUS in the ED. : This retrospective study used an interrupted time series analysis to assess how interventions changed the use of POCUS in the emergency department of a tertiary medical institute in South Korea from October 2016 to February 2021. We chose two main interventions-expansion of benefit coverage of the National Health Insurance (NHI) for emergency ultrasound (EUS) and annual ultrasound educational workshops. The primary variable was the EUS rate, defined as the number of EUS scans per 1000 eligible patients per month. We compared the level and slope of EUS rates before and after interventions. : A total of 5188 scanned records were included. Before interventions, the EUS rate had increased gradually. After interventions, except for the first workshop, the EUS rate immediately increased significantly ( < 0.05). The difference in the EUS rate according to the expansion of the NHI was estimated to be the largest ( < 0.001). However, the change in slope significantly decreased after the third workshop during the coronavirus disease 2019 pandemic ( = 0.004). The EUS rate increased significantly in the presence of physicians participating in intensive POCUS training ( < 0.001). : This study found that expansion of insurance coverage for EUS and ultrasound education led to a significant and immediate increase in the use of POCUS, suggesting that POCUS use can be increased by improving education and insurance benefits.

摘要

即时超声检查(POCUS)是一种有助于临床医生在急诊科正确治疗患者的有用工具。本研究旨在评估特定干预措施对急诊科 POCUS 使用的影响。

这项回顾性研究使用中断时间序列分析来评估干预措施如何改变韩国一家三级医疗机构急诊科的 POCUS 使用情况,从 2016 年 10 月至 2021 年 2 月。我们选择了两个主要干预措施:扩大国家健康保险(NHI)对急诊超声(EUS)的福利覆盖范围和每年的超声教育研讨会。主要变量是 EUS 率,定义为每月每 1000 名合格患者的 EUS 扫描次数。我们比较了干预前后 EUS 率的水平和斜率。

共有 5188 个扫描记录被纳入。在干预之前,EUS 率逐渐增加。干预后,除了第一次研讨会外,EUS 率立即显著增加(<0.05)。据估计,NHI 扩大后 EUS 率的差异最大(<0.001)。然而,在 2019 年冠状病毒病大流行期间第三次研讨会之后,斜率的变化明显下降(=0.004)。在参加强化 POCUS 培训的医生存在的情况下,EUS 率显著增加(<0.001)。

本研究发现,扩大 EUS 保险覆盖范围和超声教育导致 POCUS 使用的显著和立即增加,这表明通过改善教育和保险福利可以增加 POCUS 的使用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/663a/8878237/3d841d64513c/medicina-58-00217-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/663a/8878237/fc4ba21d7930/medicina-58-00217-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/663a/8878237/143be66d8344/medicina-58-00217-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/663a/8878237/3d841d64513c/medicina-58-00217-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/663a/8878237/fc4ba21d7930/medicina-58-00217-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/663a/8878237/143be66d8344/medicina-58-00217-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/663a/8878237/3d841d64513c/medicina-58-00217-g003.jpg

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本文引用的文献

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Clin Exp Emerg Med. 2021 Dec;8(4):307-313. doi: 10.15441/ceem.20.136. Epub 2021 Dec 31.
2
The Use of Point-of-care Ultrasound in Emergency Medical Centers in Korea: a National Cross-sectional Survey.韩国急救医疗中心中即时超声的应用:一项全国性的横断面调查。
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3
Current Use, Perceived Barriers, and Learning Preference of Point of Care Ultrasound (POCUS) in the Emergency Medicine in Qatar - A Mixed Design.
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Open Access Emerg Med. 2021 May 18;13:177-182. doi: 10.2147/OAEM.S304153. eCollection 2021.
4
Impact of the COVID-19 pandemic on radiology department emergency ultrasound utilization.COVID-19 大流行对放射科急诊超声检查利用的影响。
Emerg Radiol. 2021 Oct;28(5):869-875. doi: 10.1007/s10140-021-01936-z. Epub 2021 Apr 29.
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