Estimated effect of asthma case management using propensity score methods.
Estimated effect of asthma case management using propensity score methods.
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发表时间：
2010-04
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通讯作者：
S. Brandt;S. Gale;I. Tager
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作者：
S. Brandt;S. Gale;I. Tager
目的评估国家哮喘控制计划中哮喘干预措施的治疗效果。研究设计横断面；通过使用倾向性分数匹配参与者和可比非参与者之间的结果差异。方法从Medicaid Claims数据库中提取参与哮喘病例管理的儿童(n=270)和未参与病例管理的合格儿童(n=2742)的数据。我们构建了医疗卫生利用、社会人口学和社区特征的衡量标准。在建立了一个与参与者在参与前的所有特征方面相似的对照组后，我们评估了该计划对哮喘结局的影响。结果与非参与者相比，参与者更有可能接种肺部疾病疫苗(95%可信区间=1.82，4.81)，更有可能在项目结束后服用控制药物处方(95%CI=1.07，2.19)，更有可能补充救援药物(95%CI=1.07，2.07)。两组之间雾化治疗或急诊科就诊的次数在统计学上没有显著差异。结论该计划确实增加了参与者对预防性保健的使用。在我们研究的时间段内，这些行为并没有减少哮喘恶化的医疗保健利用率。我们无法辨别出缺乏效果是因为程序的性质，效果的异质性，还是程序控制之外的障碍。
OBJECTIVE To estimate the treatment effect of participation in an asthma intervention that was part of the National Asthma Control Program. STUDY DESIGN Cross-sectional; difference in outcomes between participants and comparable nonparticipants matched by using propensity scores. METHODS Data on children who participated in asthma case management (n = 270) and eligible children who did not participate in case management (n = 2742) were extracted from a Medicaid claims database. We constructed measures of healthcare utilization, sociodemographics, and neighborhood characteristics. After creating a comparison group similar to the participants in terms of all characteristics before participation, we estimated the effect of the program on asthma outcomes. RESULTS Participants were more likely to have vaccinations for pulmonary illness (95% confidence interval [CI] = 1.82, 4.81), to fill a prescription for controller medications (95% CI = 1.07, 2.19), and to have a refill for rescue medication (95% CI = 1.07, 2.07) after the program than comparable nonparticipants. There was no statistically significant difference in the number of nebulizer treatments or emergency department visits between the 2 groups. CONCLUSIONS The program did increase the use of preventive healthcare by participants. Over the time period we studied, these behaviors did not decrease healthcare utilization for asthma exacerbations. We were unable to discern whether the lack of effect was because of the nature of the program, heterogeneity of the effects, or barriers outside the program's control.