Dedicated Asthma Center Improves the Quality of Care and Resource Utilization for Pediatric Asthma: A Multicenter Study
作者:David S. Battleman、Mark A. Callahan、Steven Silber、Cynthia I. Mun∼oz、Lucia Santiago、Joseph Abularrage、Hadi Jabbar
DOI:10.1111/j.1553-2712.2001.tb00189.x
日期:2001.7
Objectives: To determine the relative effectiveness of pediatric asthma care among patients treated by a dedicated asthma center (AC) vs children who use the emergency department (ED) as a site of primary asthma care. Methods: A retrospective case—control design was used. A random sample of AC cases was selected from a designated comprehensive AC over a 12‐month period. Concurrent ED control patients were identified from all cases of pediatric asthma from five urban hospitals based on two or more ED visits. Cases and controls were matched (1:2) based on age and National Heart, Lung, and Blood Institute (NHLBI) asthma severity of illness classification. A telephone survey was administered to the caregivers of all enrolled patients in the study sample. Results: Four elements of pediatric asthma care were examined: quality, access, hospital utilization, and functional impact of disease. Demographic data were similar between the ED cases and the AC controls. In terms of quality of care, the AC patients were more likely to use maintenance antiinflammatory medications, 60.2% vs 22.5% (OR = 5.3; 95% CI = 2.9 to 9.7) and more likely to be taking medications at school, 71.4% vs 48.1% (OR = 2.7; 95% CI = 1.5 to 4.7). In terms of access to care, the AC families were more likely to have a physician to call to assist with outpatient management, 98.2% vs 65.0% (OR = 25.3; 95% CI = 9.0 to 76.9). Frequent ED utilization (≥ 1 visit/month) was less likely in the AC patients, 9.2% vs 22.0% (OR = 0.35; 95% CI = 0.16 to 0.79) and school absenteeism was lower as well (9.5 ± 6.7 days vs 16.6 ± 10.3, p < 0.001). Additionally, the caregivers of the AC patients missed fewer workdays (4.7 ± 2.8 vs 7.4 ± 4.1; p = 0.03). Conclusions: Significant disparities in quality, access, resource utilization, and functional impact exist between AC and ED patients. Emergency physicians have a unique opportunity to improve the public health by directing ED patients toward pediatric AC treatment.
**目标:** 确定儿童哮喘治疗在由专门哮喘中心(AC)治疗的患者与将急诊科(ED)作为主要哮喘治疗场所的儿童之间的相对疗效。
**方法:** 使用回顾性病例对照设计。从指定的综合性哮喘中心随机选择AC病例,时间跨度为12个月。对照组ED患者根据两次或以上的ED就诊次数从五所城市医院的所有儿科哮喘病例中确定。病例和对照组根据年龄和美国国立心肺血液研究所(NHLBI)哮喘严重程度分类以1:2的比例进行匹配。向研究样本中所有入组患者的看护者进行了电话调查。
**结果:** 检查了儿童哮喘治疗的四个要素:质量、可及性、住院利用和疾病的功能影响。ED病例和AC对照组的人口统计数据相似。在治疗质量方面,AC患者更有可能使用维持性抗炎药物,60.2% vs 22.5% (OR = 5.3; 95% CI = 2.9 至 9.7),并且更有可能在学校服药,71.4% vs 48.1% (OR = 2.7; 95% CI = 1.5 至 4.7)。在治疗可及性方面,AC家庭更有可能有一个可以联系的医生来协助门诊管理,98.2% vs 65.0% (OR = 25.3; 95% CI = 9.0 至 76.9)。频繁的ED利用(≥ 1 次/月)在AC患者中不太可能,9.2% vs 22.0% (OR = 0.35; 95% CI = 0.16 至 0.79),缺课率也较低(9.5 ± 6.7 天 vs 16.6 ± 10.3 天, p < 0.001)。此外,AC患者看护者缺工时间也较少(4.7 ± 2.8 vs 7.4 ± 4.1 天; p = 0.03)。
**结论:** 在质量、可及性、资源利用和疾病影响方面,AC和ED患者之间存在显著差异。急诊医生有独特的机会通过将ED患者引导至儿科哮喘中心治疗来改善公共健康。