Effect of compliance with health supervision guidelines among US infants on emergency department visits
Effect of compliance with health supervision guidelines among US infants on emergency department visits
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DOI：
10.1001/archpedi.156.10.1015
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发表时间：
2002-10-01
影响因子：
--
通讯作者：
Ronsaville, DS
中科院分区：
文献类型：
--
作者：
Hakim, RB;Ronsaville, DS
背景：很少有研究表明遵守早期定期健康监督对健康有益。目的：研究急诊科（ED）的使用与对美国儿童国家队列中可能避免的疾病进行定期健康监督的现行指南的依从性之间的关系。设计：这是一项历史性的队列研究，结合了来自1988年全国母婴健康调查及其1991年纵向随访研究的孕产妇和初级保健医生关于婴儿在出生后头7个月使用预防性保健服务的报告。Cox比例风险生存回归中使用的预防保健量表预测了选定诊断和控制疾病严重程度的全因就诊的首次急诊科就诊时间。结果：在前6个月的儿童中，因上呼吸道感染（风险比为2.3,95%可信区间为1.6-3.2）、胃肠炎（风险比为1.8,95%可信区间为1.0-3.0）、哮喘（风险比为2.1,95%可信区间为1.0-4.3）和全因ED就诊（风险比为1.6,95%可信区间为1.4-1.98）而就诊的风险增加。结论：由于遵守国家早期儿童保健指南对降低经历ED使用的风险具有积极作用，因此国家提高幼儿儿童保健服务质量的努力应侧重于提高幼儿定期预防性保健的依从性。
Background: There are few studies that demonstrate the health benefit of compliance with early periodic health supervision.Objective: To examine the association between emergency department (ED) use and compliance with prevailing guidelines for periodic health supervision for conditions that potentially could be avoided among a national cohort of US children.Design: This was a historic cohort study that combined maternal and primary care physician reports of the use of preventive care services for infants during the first 7 months of life from the 1988 National Maternal and Infant Health Survey and its 1991 Longitudinal Follow-up study. A preventive care scale used in Cox proportional hazards survival regression predicted the time to the first ED visit for selected diagnoses and all-cause visits controlling for illness severity.Results: Among children with incomplete well-child care in the first 6 months of life, there was an increased risk of having an ED visit for an upper respiratory tract infection (hazard ratio, 2.3; 95% confidence interval, 1.6-3.2), gastroenteritis (hazard ratio, 1.8; 95% confidence interval, 1.0-3.0), asthma (hazard ratio, 2.1; 95% confidence interval, 1.0-4.3), and all-cause ED visits (hazard ratio, 1.6; 95% confidence interval, 1.4-1.98).Conclusions: Because of the positive effect compliance with national guidelines for early well-child care has on lowering the risk of experiencing ED use, national efforts to improve the quality of child health services for young children should focus on increasing compliance with periodic preventive care for young children.