Use of asthma guidelines by primary care providers to reduce hospitalizations and emergency department visits in poor minority, urban children
Use of asthma guidelines by primary care providers to reduce hospitalizations and emergency department visits in poor minority, urban children
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DOI：
10.1016/j.jpeds.2004.12.017
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发表时间：
2005-05-01
影响因子：
5.1
通讯作者：
Bailit, H
中科院分区：
文献类型：
--
作者：
Cloutier, MM;Hall, CB;Bailit, H
目的 确定初级保健提供者 (PCP) 提供的有组织的全市哮喘管理计划是否会提高对国家哮喘教育和预防计划 (NAEPP) 哮喘指南的遵守率，以及 PCP 对指南的遵守是否会降低低收入少数族裔儿童的医疗服务利用率。 研究设计 对 3748 名哮喘儿童的医疗服务利用情况进行分析，这些儿童在康涅狄格州哈特福德市的 6 个初级保健城市诊所之一就诊，并被纳入其中1998 年 6 月 1 日至 2002 年 8 月 31 日期间，参加了一项疾病管理计划（Easy Breathing (TM)）。 结果 在 3748 名经医生确诊患有哮喘的儿童中，48% 患有持续性疾病。加入 Easy Breathing 后，吸入皮质类固醇的付费索赔增加了 25% (P < .0001)。提供者遵守 NAEPP 抗炎治疗指南的比例从 38% 增加到 96%。 Easy Breathing 哮喘儿童的总体住院率降低了 35% (P < .006)，哮喘急诊 (ED) 就诊次数减少了 27% (P <.01)，门诊就诊次数减少了 19% (P < 0001)。 结论 组织化的疾病管理计划提高了城市诊所中 PCP 抗炎使用 NAEPP 指南的遵守率。 PCP 遵守指南中的这一要素可以减少哮喘儿童的住院、急诊就诊和门诊就诊。
Objectives To determine whether an organized, citywide asthma management program delivered by primary care providers (PCPs) increases adherence to the National Asthma Education and Prevention Program (NAEPP) Asthma Guidelines and whether adherence to the guidelines by PCPs decreases medical services utilization in low-income, minority children.Study design Analysis of the utilization of medical services for a cohort of 3748 children with asthma who presented for care at one of six primary care urban clinics in Hartford, Connecticut, and who were enrolled in a disease management program (Easy Breathing (TM)) between June 1, 1998 and August 31, 2002.Results Of the 3748 children with physician-confirmed asthma, 48% has persistent disease. Paid claimes for inhaled corticosteroids increased 25% (P < .0001) after enrollment in Easy Breathing. Provider adherence to the NAEPP guidelines for anti-inflammatory therapy increased from 38% to 96%. Easy Breathing children with asthma experienced a 35% decrease in overall hospitalization rates (P < .006), a 27% decrease in asthma emergency department (ED) visits (P < .01), and a 19% decrease in outpatient visits (P < 0001).Conclusions An organized, disease management program increased adherence to the NAEPP guidelines for anti-inflammatory use by PCPs in urban clinics. Adherence to this element of the guidelines by PCPs reduced hospitalizations, ED visits, and outpatient visits for children with asthma.