Defining localities of inadequate treatment for childhood asthma: a GIS approach.
Defining localities of inadequate treatment for childhood asthma: a GIS approach.
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DOI：
10.1186/1476-072x-5-3
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发表时间：
2006-01-17
影响因子：
4.9
通讯作者：
Tal A
中科院分区：
文献类型：
--
作者：
Peled R;Reuveni H;Pliskin JS;Benenson I;Hatna E;Tal A
地理信息系统(GIS)的使用在慢性病的管理以及临床和行政保健数据的分析方面具有巨大的潜力。哮喘是一种慢性疾病，与大量的发病率、死亡率和医疗保健使用有关。来自世界各地的流行病学数据表明，尽管有有效的治疗方法，哮喘的发病率和死亡率仍在上升。这些事实导致了为提高哮喘护理质量而制定的战略的出现。利用地理信息系统开发有效的质量保证和慢性病管理工具。以色列南部地区。1998年1月至2000年10月以色列最大的医疗保健组织的行政索赔数据：药品配药登记、人口统计数据、急诊室就诊和住院数据库。根据以色列临床指南，我们创建了儿童哮喘药物治疗不足的六个标志物清单。我们使用这个列表来搜索药品分配登记，以确定哪些哮喘儿童没有得到足够的治疗，并评估他们的卫生保健利用情况和不良结果：急诊室就诊和住院。使用地理信息系统，我们创建了专题地图，在这些地图上，我们确定了诊所的位置，其中有很高比例的儿童接受的治疗不符合临床指南。81%的儿童被发现至少有一个标记表明治疗不充分；17.5%的儿童被发现有不止一个标记。有标志物的儿童与没有标志物的儿童相比，急诊室就诊率、住院率和住院时间都有统计学意义上的显著提高。这些地图以一种强有力的方式显示了哪些诊所提供的治疗与临床指南不符。这些诊所的急诊室就诊率、住院率和住院时间都很高。临床指南、管理数据和地理信息系统的集成可以在管理信息和临床信息之间创建一个有效的接口。该工具可用于分配用于质量保证干预的地点。
The use of Geographic Information Systems (GIS) has great potential for the management of chronic disease and the analysis of clinical and administrative health care data. Asthma is a chronic disease associated with substantial morbidity, mortality, and health care use. Epidemiologic data from all over the world show an increasing prevalence of asthma morbidity and mortality despite the availability of effective treatment. These facts led to the emergence of strategies developed to improve the quality of asthma care. To develop an efficient tool for quality assurance and chronic disease management using a Geographic Information System (GIS). The southern region of Israel. January 1998 – October 2000. Administrative claims data of the largest HMO in Israel: drug dispensing registry, demographic data, Emergency Room visits, and hospitalization data bases. We created a list of six markers for inadequate pharmaceutical treatment of childhood asthma from the Israeli clinical guidelines. We used this list to search the drug dispensing registry to identify asthmatic children who received inadequate treatment and to assess their health care utilization and bad outcomes: emergency room visits and hospitalizations. Using GIS we created thematic maps on which we located the clinics with a high percentage of children for whom the treatment provided was not in adherence with the clinical guidelines. 81% of the children were found to have at least one marker for inadequate treatment; 17.5% were found to have more than one marker. Children with markers were found to have statistically significant higher rates of Emergency Room visits, hospitalizations and longer length of stay in hospital compared with children without markers. The maps show in a robust way which clinics provided treatment not in accord with the clinical guidelines. Those clinics have high rates of Emergency Room visits, hospitalizations and length of stay. Integration of clinical guidelines, administrative data and GIS can create an efficient interface between administrative and clinical information. This tool can be used for allocating sites for quality assurance interventions.