The impact of allergy and pulmonary specialist care on emergency asthma utilization in a large managed care organization
The impact of allergy and pulmonary specialist care on emergency asthma utilization in a large managed care organization
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DOI：
10.1111/j.1475-6773.2005.00410.x
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发表时间：
2005-10-01
影响因子：
3.4
通讯作者：
Eisner, MD
中科院分区：
文献类型：
--
作者：
Erickson, S;Tolstykh, I;Eisner, MD
目标。目的：评价哮喘专科护理对哮喘急诊就诊和住院风险的纵向影响。使用电话调查和计算机利用数据的前瞻性队列研究。研究设计。我们招募了4742名因哮喘住院(基线住院)的封闭式小组管理型护理组织的成年成员组成的前瞻性队列。哮喘专家的就诊是从计算机化的使用数据库中确定的。基线住院后的专科就诊被定义为时间依赖协变量。另一项分析定义了基线住院前一年的专科就诊情况。596名受试者完成了电话采访。主要发现。与基线住院后没有接受专科就诊的受试者相比，在整个队列中，过敏症专科医生(危险比(HR)1.04；95%可信区间(CI)0.87-1.26)或肺科专科医生(HR 0.92；95%可信区间0.71-1.19)的治疗与未来因哮喘而去急诊室就诊的风险降低无关，并控制了年龄、性别、种族、最近哮喘药物配药和药房福利状况。过敏症专科医生就诊与随后因哮喘住院的风险之间也没有关联(HR为0.93；95%CI为0.75-1.14)。相反，去看肺科医生(HR为0.74；95%CI为0.55-0.99)与再住院风险降低有关。肺科专科就诊似乎降低了哮喘住院的风险，而哮喘专科就诊并不能减少急诊的风险。在全面预付保健的背景下，专科护理的好处不大。
Objective. To evaluate the longitudinal impact of asthma specialist care on the risk of emergency department (ED) visits and hospitalization for asthma.Data Sources/Study Setting. A prospective cohort study using both telephone survey and computerized utilization data.Study Design. We recruited a prospective cohort of 4,742 adult members of a closed panel managed care organization who were hospitalized for asthma (the "baseline hospitalization").Data Collection/Extraction Methods. Visits to asthma specialists were ascertained from computerized utilization databases. Specialist visits after baseline hospitalization were defined as time-dependent covariates. An alternative analysis defined specialist visits during the year preceding baseline hospitalization. A subcohort of 596 subjects completed telephone interviews.Principal Findings. Compared with subjects who received no specialist visits after baseline hospitalization, treatment by allergists (hazard ratio (HR) 1.04; 95 percent confidence interval (CI) 0.87-1.26) or pulmonologists (HR 0.92; 95 percent CI 0.71-1.19) was not associated with a reduction in the risk of future ED visits for asthma in the entire cohort, controlling for age, sex, race, recent asthma medication dispensing, and pharmacy benefits status. There was also no association between allergist visits and the risk of subsequent hospitalizations for asthma (HR 0.93; 95 percent CI 0.75-1.14). In contrast, visits to pulmonologists (HR 0.74; 95 percent CI 0.55-0.99) were related to a reduced risk of rehospitalization.Conclusions. Pulmonary specialist visits appeared to reduce the risk of hospitalization for asthma, whereas asthma specialist visits did not reduce the risk of ED visits. In the context of comprehensive prepaid health care, the benefit of specialist care was modest.