Diagnostic accuracy of asthma within a health maintenance organization.
Diagnostic accuracy of asthma within a health maintenance organization.
复制标题
健康维护组织内哮喘的诊断准确性。
DOI：
10.1016/0895-4356(92)90041-k
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发表时间：
1992
影响因子：
7.2
通讯作者：
Buist,AS
中科院分区：
文献类型：
--
作者：
Osborne,ML;Vollmer,WM;Buist,AS
据报道，美国的哮喘发病率和死亡率正在增加。我们提出了一种解释，即哮喘诊断的准确性正在发生变化。对健康维护组织 (HMO) 1970-1973 年和 1980-1983 年期间有哮喘诊断的 320 份住院和门诊记录进行了评估。我们确定我们与图表诊断的一致性是否取决于以下因素：性别、治疗时间、住院与门诊环境、哮喘是否是主要或次要诊断以及患者年龄。比较的标准是专家小组评审，其中将哮喘分为六类。在住院患者 (97%) 和门诊患者 (94%) 中，大多数检查图表显示出与哮喘一致的临床表现。狭义定义的“明确哮喘”类别的发病率因年龄而异，20岁以下年龄组的比例最高（74%），60岁以上年龄组的比例最低（46%），可能是因为老年人往往同时患有与吸烟相关的疾病。从 20 世纪 70 年代到 80 年代，门诊患者中“明确哮喘”的增加可能反映了医生中图表记录的增加，说明需要对哮喘体征和症状进行清晰、一致的图表记录。
Reported asthma morbidity and mortality are increasing in the U.S. We addressed one explanation, that the accuracy of the diagnosis of asthma is changing. The diagnosis of asthma was evaluated in 320 inpatient and outpatient records bearing the diagnosis of asthma for the periods 1970–1973 and 1980–1983 in a health maintenance organization (HMO). We determined whether or not our agreement with the chart diagnosis was a function of: sex, period of treatment, inpatient vs outpatient setting, whether or not asthma was the primary or secondary diagnosis, and patient age. The standard of comparison was an expert panel review in which asthma was divided into six categories. In both inpatient (97%) and outpatient settings (94%), the majority of charts examined exhibited a clinical picture consistent with asthma. The rate of the narrowly defined “definite asthma” category varied with respect to age, with the highest proportion in the under 20-year age group (74%) and the lowest (46%) in the over 60 age groups, probably because older individuals often have coexisting smoking related diseases. The increase in “definite asthma” among outpatients from the 1970s to the 1980s likely reflects increasing chart documentation among physicians, illustrating the need for clear, consistent chart documentation of signs and symptoms of asthma.