個案管理可提升自費低劑量肺部電腦斷層之追蹤率──單一中心之回溯性研究

Case Management System Increases the Follow-up Rate of Self-paid Low-dose Computerized Tomography for Lung Cancer Screening: A Single-Center Retrospective Study

目的：探討個案管理（以下簡稱「個管」）是否能提升自費低劑量肺部電腦斷層發現病灶的受檢者的追蹤率。方法：本研究回溯性蒐集2017年03月01日至2018年04月30日於成大醫院健康管理中心接受低劑量肺部電腦斷層檢查的受檢者資料進行研究。主要收案條件為年齡20歲以上、第一次於本中心接受肺部電腦斷層且符合早期肺癌變化需追蹤的受檢者。受檢者依個管建立前後分為2組，並比較組間年齡、性別、吸菸、肺癌家族史（三等親內罹患肺癌者）、病灶大小型態等臨床特徵及追蹤率的差異，並利用多變項羅吉斯迴歸分析影響受檢者接受追蹤的獨立因子，也使用傾向分數匹配排除組間差異作為敏感性分析。結果：經篩選後共有386位受檢者納入本研究中。個管建立後的受檢者接受追蹤的比率比較高（個管建立後：67.6%，個管建立前：43.9%，p＜0.001）。多變項羅吉斯迴歸分析顯示個管是受檢者接受追蹤的獨立因子（校正後勝算比：2.65，95%信賴區間：1.74-4.03，p＜0.001）。傾向分數匹配後多變項羅吉斯迴歸分析仍顯示個管是接受追蹤的獨立因子（校正後勝算比：2.72，95%信賴區間：1.68-4.39，p＜0.001）。結論：本研究結果顯示個管能提升受檢者的追蹤率。但受檢者的生活品質及臨床預後是否因此提升，以及此模式是否符合成本效應仍有待未來的研究探討。

Purpose: The study aimed to investigate the effectiveness of case management and consultation clinic service in improving the follow-up rates of patients with lung lesions discovered by self-paid low dose computerized tomography (LDCT) lung cancer screening. Methods: We retrospectively collected information from subjects receiving LDCT lung cancer screening from March 01, 2017 to April 30, 2018 in the Health Management Center of National Cheng Kung University Hospital. The main inclusion criteria were a minimum age of 20 years, first LDCT in our unit, and the presence of lung lesions consistent with early-stage lung cancer. The enrolled subjects were divided into two groups based on whether they received case management intervention. Multivariable logistic regression analysis was performed to determine the independent factors associated with the following-up rate. Propensity score matching was used for sensitivity analysis. Results: A total of 386 subjects were enrolled in the study. The follow-up rate was higher in subjects with case management (67.6% with case management vs. 43.9% without case management; p value ＜ 0.001). Based on the results of multivariable analysis, case management was independently associated with follow-up rate (adjusted odds ratio: 2.65; 95% confidence interval: 1.74 to 4.03; p value ＜ 0.001). After propensity score matching, multivariable analysis continued to indicate that case management was independently associated with follow-up rate (adjusted odds ratio: 2.72; 95% confidence interval: 1.68 to 4.39; p value ＜ 0.001). Conclusion: Case management helps improve the follow-up rate of subjects with lung lesions on LDCT. Further investigations are needed to determine its cost-effectiveness and influences on the quality of life and clinical prognosis of patients.