Outcomes associated with spirometry for pediatric asthma in a managed care organization
Outcomes associated with spirometry for pediatric asthma in a managed care organization
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DOI：
10.1542/peds.2005-2352
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发表时间：
2006-07-01
期刊：
影响因子：
8
通讯作者：
Dombkowski, KJ
中科院分区：
文献类型：
--
作者：
Cabana, M;Slish, KK;Dombkowski, KJ
背景美国国家心脏、肺和血液研究所哮喘指南建议哮喘儿童至少每1至2年接受一次肺量计测试，以评估气道功能的维持情况。“客观。这项工作的目的是描述：（1）哮喘儿童接受肺功能测定的频率，（2）与接受肺功能测定相关的因素，（3）肺功能测定对随后的哮喘急诊的影响。方法我们分析了来自一个大学管理式医疗机构的所有儿童哮喘索赔数据，为期3年（2001年1月至2003年12月）。我们纳入了所有连续入组的7 - 21岁活动性哮喘患者。我们关注的结果是肺功能测定（通用程序术语94010-6、94060、94070或94150）的≥ 1次要求和急诊就诊时间。我们使用多变量逻辑回归来确定与接受肺量测定相关的因素，并使用生存分析技术来评估接受肺量测定与下一年急诊哮喘就诊可能性之间的关联，控制患者年龄、性别、疾病严重程度和保险类型。有2688名符合条件的儿童，其中1509名（56%）是男性，324名（12%）有医疗保险，624名（24%）在第一年患有持续性哮喘。在2688名儿童中，只有612名（23%）在研究期间进行了≥ 1次肺量测定。在所有的多变量逻辑分析模型中，疾病严重程度的增加与接受肺功能测定的可能性增加一致相关。与没有医疗补助保险的患者相比，有医疗补助保险的儿童始终不太可能接受肺量测定测试。在调整年龄、性别、严重程度和保险类型后，接受肺量测定并不影响未来急诊哮喘使用的可能性。
BACKGROUND. The National Heart, Lung and Blood Institute asthma guidelines recommend that children with asthma receive spirometry testing "at least every 1 to 2 years to assess the maintenance of airway function."OBJECTIVE. The purpose of this work was to describe: (1) how often children with asthma receive spirometry testing, (2) what factors are associated with receipt of spirometry testing, and (3) the impact of spirometry testing on subsequent emergency department visits for asthma.METHODS. We analyzed all pediatric asthma claims data from a university-based managed care organization for a 3-year period (January 2001 to December 2003). We included all of the continuously enrolled patients with active asthma between 7 and 21 years of age. Our outcomes of interest were the presence of >= 1 claim for spirometry testing (Common Procedural Terminology 94010-6, 94060, 94070, or 94150) and the time to emergency department visit. We used multivariate logistic regression to determine factors associated with receipt of spirometry and survival analyses techniques to assess the association between receipt of spirometry with the likelihood of an emergency department asthma visit in the next year, controlling for patient age, gender, severity of illness, and type of insurance.RESULTS. There were 2688 eligible children of whom 1509 (56%) were male, 324 (12%) had Medicaid insurance, and 624 (24%) had persistent asthma in the initial year. Of the 2688 children, only 612 (23%) had >= 1 claim for spirometry testing during the study period. In all of the multivariate logistic analysis models, increased severity of illness was consistently associated with increased likelihood of receiving spirometry testing. Compared with patients without Medicaid insurance, children with Medicaid insurance were consistently less likely to receive spirometry testing. After adjusting for age, gender, severity, and insurance type, receipt of spirometry did not affect the likelihood of future emergency department asthma use.