A randomized controlled trial of a pediatric asthma outreach program
A randomized controlled trial of a pediatric asthma outreach program
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DOI：
10.1016/s0091-6749(99)70468-9
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发表时间：
1999-03-01
影响因子：
14.2
通讯作者：
Parks, P
中科院分区：
文献类型：
--
作者：
Greineder, DK;Loane, KC;Parks, P
背景：既往研究表明，哮喘教育和病例管理可以减少哮喘急救、住院治疗和支出。目的：我们试图研究哮喘外展计划（AOP）（一种基于团队的病例管理干预措施）对急诊病房（EW）和医院使用的影响。方法：57 名年龄在 1 至 15 岁、根据通常的临床实践标准诊断为哮喘的患者，他们连续参加员工模式健康维护组织一段时间。至少连续 2 年被随机分为 2 个干预组。对照组接受一次强化哮喘教育干预，BOP 组接受相同的初始教育，但在整个干预期间由哮喘病例管理护士进行随访。结果：根据入组前后一年的索赔情况评估了 EW 就诊、住院治疗和健康计划外总支出（包括 EW 和住院费用，以及杂项费用，如救护车、耐用医疗设备、三级转诊和家庭护理）。对照组患者的 EW 就诊次数 (39%)、住院次数 (43%) 和健康计划外费用 (28%) 显着减少，这可能是所有入组患者接受基线教育干预以及回归均值的结果。 AOP 组患者的 EW 就诊次数 (73%，P = .0002)、住院次数 (84%，p = .0012) 和健康计划外使用 (82%，P < .0001) 显着减少。与对照组相比，AOP 组患者的 EW 就诊次数 (57%，P < .05)、住院次数 (75%，P < .0001) 显着减少。 .05），以及健康计划外使用（71%，P < .001）。根据假设，AOP 护士工资每花费 1 美元，健康计划的直接节省估计为 7.69 美元到 11.67 美元。结论：与仅接受教育干预的随机对照组相比，员工模式健康维护组织中的哮喘患者通过参与 AOP，资源使用量减少了 57% 到 75%。与 AOP 护士的费用相比，节省了大量费用。
Background: Previous studies have shown that asthma education and case management may reduce asthma emergency care, hospitalizations, and expenditures.Objective: We sought to study the effect of an asthma outreaeh program (AOP), a team-based, case-management intervention, on emergency ward (EW) and hospital use.Methods: Fifty-seven patients aged 1 to 15 years with the diagnosis of asthma based on the usual clinical practice criteria who ere continuously enrolled in a staff-model health maintenance organization for a period of at least 2 consecutive years were randomized into 2 intervention groups. The control group received a single intensive asthma education intervention, and the BOP group received the same initial education hut then was followed-up by an asthma case management nurse throughout the intervention period.Results: EW visits, hospitalizations, and total outside-of-health-plan expenditures (consisting of EW and hospital expenses, as well as miscellaneous costs, such as ambulance, durable medical equipment, tertiary referrals, and home care) were assessed from claims pled for a year before and after enrollment. Control group patients experienced significant reductions in EW visits (39%), hospitalizations (43%), and outside-of-health-plan costs (28%), possibly as a result of the baseline educational intervention received by all enrolled patients, in conjunction with regression to the mean. AOP group patients experienced significant reductions in EW visits, (73 %, P = .0002), hospitalizations (84% p = .0012), and outside-of-health-plan use (82%, P < .0001), When compared with the control group, AOP group patients demonstrated additional significant reductions in EW visits (57%, P < .05), hospitalizations (75%, P < .05), and outside-of-health-plan use (71%, P < .001). Estimates of direct savings to the health plan ranged from $7.69 to $11.67 for every dollar spent on the AOP nurse's salary, depending on assumptions,Conclusions: Asthma patients in a staff-model health maintenance organization decreased their resource use between 57% to 75% by participation in an AOP as compared with a randomized control group receiving only an educational intervention. Substantial savings were achieved compared with the cost of the AOP nurse.