哮喘联盟

   摘要
   背景：虽然哮喘专科诊疗可有效改善儿童哮喘结局，但是，初级医疗保健的影响仍然是个未知数。
   目的：本研究旨在评估儿科初级医疗哮喘预防保健和急性发作诊疗服务的变化是否会影响患者结局。
   方法：本研究通过查阅病例、电话访问儿童父母，共收集了22个机构948例3-12岁哮喘儿童、为期12个月的初级医疗提供的预防保健（哮喘维持期就诊次数≥1次/年）和急性发作诊疗（哮喘急性发作诊疗次数≥1次/年）服务相关资料。运用广义估计方程评价医疗机构的这些干预措施与个体哮喘结局（无症状天数、父母生活质量、急诊就诊次数、住院次数）的关系，并对季节性因素、专科诊疗、医疗补助、单亲家庭和种族进行校正。
   结果：接受预防保健服务的儿童比例每增加10%，则无症状天数增加7.6天/儿童(p = 0.02)、急诊次数减少16.5%/儿童(p = 0.002)，父母生活质量和住院次数无变化。校正分析中，仅预防保健接受越多与急诊就诊次数减少有关(减少12.2%; p = 0.03)。急性发作诊疗每增加10%，急诊就诊次数和住院次数分别下降18.1%/儿童(p = 0.02)和16.5%/儿童(p < 0.001)，校正分析结果类似（急诊就诊次数下降8.6%/儿童，p = 0.02；住院次数下降13.9%/儿童，p = 0.03）。
   结论：初级医疗机构为哮喘儿童提供的预防保健和急性发作诊疗服务越多，越有利于改善哮喘结局，包括降低功能性损害和相关风险。校正分析中风险结局改善依然存在，提示医疗机构采取的加强哮喘管理的干预措施，有利于进一步降低儿童哮喘的差异。

 

（杨冬 审校）
J Allergy Clin Immunol Pract. 2016 Jan 20.pii: S2213-2198(15)00786-2. doi: 10.1016/j.jaip.2015.12.011. [Epub ahead of print]

 

Practice Variation in Management of Childhood Asthma Is Associated with Outcome Differences.
 

Garbutt JM1, Yan Y2, Strunk RC3.
 

Abstract
BACKGROUND:Although specialist asthma care improves children's asthma outcomes, the impact of primary care management is unknown.
OBJECTIVE:To determine whether variation in preventive and acute care for asthma in pediatric practices affects patients' outcomes.
METHODS:For 22 practices, we aggregated 12-month patient data obtained by chart review and parent telephone interviews for 948 children, 3 to 12 years old, diagnosed with asthma to obtain practice-level measures of preventive (≥1 asthma maintenance visit/year) and acute (≥1 acute asthmavisit/year) asthma care. Relationships between practice-level measures and individual asthma outcomes (symptom-free days, parental quality of life, emergency department [ED] visits, and hospitalizations) were explored using generalized estimating equations, adjusting for seasonality, specialist care, Medicaid insurance, single-family status, and race.
RESULTS:For every 10% increase in the proportion of children in the practice receiving preventive care, symptom-free days per child increased by 7.6 days (P = .02) and ED visits per child decreased by 16.5% (P = .002), with no difference in parental quality of life or hospitalizations. Only the association between more preventive care and fewer ED visits persisted in adjusted analysis (12.2% reduction; P = .03). For every 10% increase in acute care provision, ED visits per child and hospitalizations per child decreased by 18.1% (P = .02) and 16.5% (P < .001), respectively, persisting in adjusted analyses (ED visits 8.6% reduction, P = .02; hospitalizations 13.9%, P = .03).
CONCLUSIONS:Children cared for in practices providing more preventive and acute asthma care had improved outcomes, both impairment and risk. Persistence of improved risk outcomes in the adjusted analyses suggests that practice-level interventions to increase asthma care may reduce childhood asthma disparities.
 

J Allergy Clin Immunol Pract. 2016 Jan 20.pii: S2213-2198(15)00786-2. doi: 10.1016/j.jaip.2015.12.011. [Epub ahead of print]