Doctoral Program in Medicine and Health Sciences, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, D.I. Yogyakarta, 55281, Indonesia.
Orthopedics and Traumatology, RSUP Dr. Sardjito Hospital, Jl. Kesehatan Sendowo, , Sleman, D.I. Yogyakarta, 55281, Indonesia.
F1000Res. 2024 Jul 9;13:333. doi: 10.12688/f1000research.146118.2. eCollection 2024.
Patients with Metastatic Bone Disease (MBD) often present with complaints of pain and multiple osteolytic lesions findings. Remarkably, 30% of these cases exhibit an undetected primary lesion. Hence, categorizing them as MBD of unknown origin. The diagnostic processes of patients with MBD of unknown origin typically takes up to four months, rendering it as a catastrophic disease with the second-highest financial burden. Given its urgency, it is necessary to develop a evidence-based consensus for managing cases of MBD with an unknown origin.
This study aimed to enhance the effectiveness and efficiency of treating patients with MBD of unknown origin through the application of the INA-MBD algorithm.
A quasi-experimental study with a pretest and post-test design was conducted with a total of 128 patients who met the inclusion and exclusion criteria. The patients were consecutively enrolled and categorized into two groups: the intervention group with the INA-MBD algorithm and the non-intervention group without the INA-MBD algorithm. The primary outcomes were the cost and time to diagnose MBD of unknown origin. The proposed measuring tool was the INA-MBD algorithm. Furthermore, for the cost-to-diagnosis variable, an extra measurement tool was used, which were summaries of the patient's medical bill including hospital stays and medical procedures. The analysis of data related to the time-to-diagnosis variable was conducted using the Log Rank regression test, and cost-to-diagnosis variable was carried out using co-variance test.
患有转移性骨病（MBD）的患者常出现疼痛和多处溶骨性病变的症状。值得注意的是，这些病例中有 30%存在未检测到的原发性病变。因此，这些病例被归类为不明原因的 MBD。不明原因 MBD 患者的诊断过程通常需要长达四个月的时间，使其成为仅次于第二大财务负担的灾难性疾病。鉴于其紧迫性，有必要制定一个基于证据的共识来管理不明原因的 MBD 病例。
本研究旨在通过应用 INA-MBD 算法来提高治疗不明原因 MBD 患者的效果和效率。
采用准实验研究，采用预测试和后测试设计，共纳入 128 名符合纳入和排除标准的患者。将患者连续纳入并分为两组：干预组采用 INA-MBD 算法，非干预组不采用 INA-MBD 算法。主要结局是诊断不明原因 MBD 的成本和时间。提出的测量工具是 INA-MBD 算法。此外，对于诊断成本变量，使用了另一个测量工具，即包括住院和医疗程序在内的患者医疗账单摘要。使用对数秩回归检验分析与诊断时间变量相关的数据，使用协方差检验进行成本-诊断变量的分析。
