Improvements in Health Care Use Associated With Community Coalitions: Long-Term Results of the Allies Against Asthma Initiative
Improvements in Health Care Use Associated With Community Coalitions: Long-Term Results of the Allies Against Asthma Initiative
复制标题
DOI：
10.2105/ajph.2012.300983
复制
发表时间：
2013-06-01
影响因子：
12.7
通讯作者：
Wilkin, Margaret
中科院分区：
文献类型：
--
作者：
Clark, Noreen M.;Lachance, Laurie L.;Wilkin, Margaret
目标.我们评估了全国各地社区低收入儿童哮喘相关医疗保健使用的变化，这些社区有6个哮喘联盟（汉普顿路，VA;华盛顿，DC;密尔沃基，WI;金县/西雅图，WA;长滩，CA;和费城，PA）动员利益相关者带来有利于哮喘控制的政策变化。盟友干预邮政编码与对照社区的家庭收入中位数，哮喘患病率，总人口规模和种族/民族相匹配。对医疗保险和医疗补助服务中心提供的关于儿童住院、急诊科（艾德）使用和医生紧急护理就诊的五年数据进行了分析。采用考克斯比例风险模型对干预和对照部位进行分层复发事件分析。在大多数评估年中，盟友社区的儿童与对照社区的儿童相比，哮喘相关住院、艾德就诊或紧急护理就诊的可能性显著降低（P <0.04）。在整个研究期间，盟友社区的儿童使用此类医疗保健的可能性显著降低（P <0.02）。动员不同的利益相关者群体，并注重政策和系统的变化，产生了显着减少卫生保健使用哮喘在脆弱社区。
Objectives. We assessed changes in asthma-related health care use by low-income children in communities across the country where 6 Allies Against Asthma coalitions (Hampton Roads, VA; Washington, DC; Milwaukee, WI; King County/Seattle, WA; Long Beach, CA; and Philadelphia, PA) mobilized stakeholders to bring about policy changes conducive to asthma control.Methods. Allies intervention zip codes were matched with comparison communities by median household income, asthma prevalence, total population size, and race/ethnicity. Five years of data provided by the Center for Medicare and Medicaid Services on hospitalizations, emergency department (ED) use, and physician urgent care visits for children were analyzed. Intervention and comparison sites were compared with a stratified recurrent event analysis using a Cox proportional hazard model.Results. In most of the assessment years, children in Allies communities were significantly less likely (P < .04) to have an asthma-related hospitalization, ED visit, or urgent care visit than children in comparison communities. During the entire period, children in Allies communities were significantly less likely (P < .02) to have such health care use.Conclusions. Mobilizing a diverse group of stakeholders, and focusing on policy and system changes generated significant reductions in health care use for asthma in vulnerable communities.