Association of Insurance Status with Severity and Management in ED Patients with Asthma Exacerbation
Association of Insurance Status with Severity and Management in ED Patients with Asthma Exacerbation
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DOI：
10.5811/westjem.2015.11.28715
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发表时间：
2016-01-01
影响因子：
3.1
通讯作者：
Camargo, Carlos A., Jr.
中科院分区：
文献类型：
--
作者：
Hasegawa, Kohei;Stoll, Samantha J.;Camargo, Carlos A., Jr.
引言：先前的研究已经证明低社会经济地位与频繁的哮喘急性发作相关。然而，最近没有多中心的努力来检查保险状况（社会经济地位的代表）与成人哮喘严重程度和管理的关系。目的是调查慢性和急性哮喘管理的差异，保险状态的成人需要急诊科（艾德）治疗在美国。方法：我们进行了一项多中心的图表审查研究（48个ED在美国23个州）的艾德患者，年龄18-54岁，急性哮喘在2011年和2012年之间。在审查随机选择的图表之前，每个研究中心都接受了培训（讲座、实践图表、认证）。我们根据患者的基本医疗保险将其分为三组：私人，公共和无保险。结果的措施是慢性哮喘的严重程度（作为衡量在一年内≥ 2艾德访问）和管理之前的索引艾德访问，急性哮喘管理在艾德，并在艾德出院处方。其中，33%有私人保险，40%有公共保险，27%没有保险。与有私人保险的患者相比，有公共保险或没有保险的患者在前一年内更可能有≥ 2次艾德就诊（分别为35%、49%和45%; p< 0.001）。尽管慢性严重程度较高，但那些没有保险的人不太可能接受指南推荐的慢性哮喘护理-即，吸入性糖皮质激素使用率（ICS [41%，41%和29%; p< 0.001]）和哮喘专科护理（9%，10%和4%; p< 0.001）较低。相比之下，艾德在急性哮喘管理方面没有显著差异-例如，使用全身性皮质类固醇（75%，79%，和78%; p=0.08）或在艾德出院时开始ICS（12%，12%，和14%; p=0.57）-通过保险状态.结论：在这个艾德急性哮喘患者的多中心观察性研究中，我们发现慢性哮喘严重程度和保险状态的管理存在显著差异。相比之下，保险组之间的急性哮喘管理没有差异。
Introduction: Previous studies have demonstrated an association of low socioeconomic status with frequent asthma exacerbations. However, there have been no recent multicenter efforts to examine the relationship of insurance status - a proxy for socioeconomic status - with asthma severity and management in adults. The objective is to investigate chronic and acute asthma management disparities by insurance status among adults requiring emergency department (ED) treatment in the United States.Methods: We conducted a multicenter chart review study (48 EDs in 23 U.S. states) on ED patients, aged 18-54 years, with acute asthma between 2011 and 2012. Each site underwent training (lecture, practice charts, certification) before reviewing randomly selected charts. We categorized patients into three groups based on their primary health insurance: private, public, and no insurance. Outcome measures were chronic asthma severity (as measured by >= 2 ED visits in one-year period) and management prior to the index ED visit, acute asthma management in the ED, and prescription at ED discharge.Results: The analytic cohort comprised 1,928 ED patients with acute asthma. Among these, 33% had private insurance, 40% had public insurance, and 27% had no insurance. Compared to patients with private insurance, those with public insurance or no insurance were more likely to have >= 2 ED visits during the preceding year (35%, 49%, and 45%, respectively; p< 0.001). Despite the higher chronic severity, those with no insurance were less likely to have guideline-recommended chronic asthma care -i.e., lower use of inhaled corticosteroids (ICS [41%, 41%, and 29%; p< 0.001]) and asthma specialist care (9%, 10%, and 4%; p< 0.001). By contrast, there were no significant differences in acute asthma management in the ED -e.g., use of systemic corticosteroids (75%, 79%, and 78%; p=0.08) or initiation of ICS at ED discharge (12%, 12%, and 14%; p=0.57) - by insurance status.Conclusion: In this multicenter observational study of ED patients with acute asthma, we found significant discrepancies in chronic asthma severity and management by insurance status. By contrast, there were no differences in acute asthma management among the insurance groups.