Temporal trends in hospital-based episodes of asthma care in a health maintenance organization.
Temporal trends in hospital-based episodes of asthma care in a health maintenance organization.
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健康维护组织中医院哮喘护理发作的时间趋势。
DOI：
10.1164/ajrccm/147.2.347
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Buist,AS
中科院分区：
文献类型：
--
作者：
Vollmer,WM;Osborne,ML;Buist,AS
研究报告称，美国和国外的哮喘住院率和死亡率增加，加剧了人们对哮喘流行病学变化的担忧。我们研究了一家大型健康维护组织的成员在两家大型社区医院发生的 20 年急性哮喘护理模式。本次演讲的重点是哮喘护理“发作”的概念化和操作化，其定义为按时间聚集的一系列遭遇（急诊室就诊、紧急护理就诊和入院），以及发作率随时间的变化。我们发现，从 1967 年到 1987 年，5 岁以下男孩的哮喘发作率在统计学上显着增加，尽管从 1985 年开始哮喘住院率有所下降，但这种情况持续有增无减。我们假设这种差异可能反映了急诊室管理实践的变化，而不是哮喘潜在流行病学的真正变化。急性哮喘护理发作的概念尚未在文献中进行研究，这代表了一种潜在有用的方法创新。特别是在管理型医疗保健系统的背景下，此类事件的研究可能不如入院研究对急性哮喘护理的组织和提供的变化敏感，因此可能更适合研究哮喘流行病学的变化。对哮喘发病率和死亡率上升的担忧促使大量研究描述了哮喘医院利用率的纵向趋势 (1-6)。这些研究普遍表明，从 20 世纪 70 年代中后期开始，因哮喘出院的人数显着增加，尤其是少数族裔和儿童。急诊室 (ER) 和其他形式的急症护理服务使用的长期趋势尚未得到充分研究 (7)。相反，大多数哮喘急诊护理研究要么考察气候现象的短期影响 (8-10)，要么考察急诊环境中的护理模式 (11-13)。除住院情况外，相对缺乏关于哮喘急性护理服务使用变化的数据，可能会导致关于哮喘流行病学模式变化的错误结论。例如，随着管理式医疗服务系统（具有减少住院治疗的经济激励）在医疗保健市场中获得越来越大的份额，预计将有越来越多的急性哮喘护理发生在门诊环境中。 Rea 和同事 (14) 甚至认为，仅用入院数据来衡量哮喘发病率是不可靠的，不应该用于此目的。在本报告中，我们提出了一种方法，用于总结大型健康维护组织 (HMO) 成员的医院哮喘护理“事件”。然后，我们利用这些事件来检查医院哮喘服务利用情况的第二季度趋势。我们所说的“以医院为基础”的护理是指两者
Studies reporting increased asthma hospitalizations and mortality in the United States and abroad have heightened concern about the changing epidemiology of asthma. We studied 20-yr patterns of acute asthma care occurring at two large community hospitals among members of a large health maintenance organization. The presentation focuses on the conceptualization and operationalization of an" episode" of asthma care, defined as a collection of encounters (emergency room visits, urgency care visits, and hospital admissions) that cluster in time, as well as on changes in episode rates over time. We found a statistically significant increase in asthma episodes among boys younger than 5 yr of age that continued unabated from 1967to 1987despite a drop in asthma hospitalization rates starting in 1985. We hypothesize that this difference may reflect a change in emergency room management practices and not a true change in the underlying epidemiology of asthma. The concept of an episode of acute asthma care has not been studied in the literature and represents a potentially useful methodologic innovation. Particularly in the context of managed health care systems, studies of such episodes may be less sensitive than studies of hospital admissions to changes in the organization and delivery of acute asthma care, and thus may be better suited for studying changes in the epidemiology of asthma.Concern about rising asthma morbidity and mortality has prompted numerous studies describing longitudinal trends in hospital utilization for asthma (1-6). These studies have generally shown evidence of a marked increase in hospital discharges for asthma, especially among minorities and children, beginning in the mid-to-Iate 1970s. Long-term trends in the utilization of emergency room (ER) and other forms of acute care services have not been well-studied (7). Instead, most studies of ER care for asthma examine either the short-term effects of climatic phenomena (8-10) or the patterns of care in the ER setting (11-13). The relative lack of data on changes in the utilization of acute care services for asthma, other than hospital admissions, may lead to erroneous conclusions about changing epidemiologic patterns of asthma. For example, as managed care delivery systems, which have a financial incentive to reduce hospitalizations, gain an increasing share of the health care market, more and more acute asthma care may be expected to occur in the outpatient setting. Rea and coworkers (14) have even argued that hospital admission data alone are unreliable as a measure of asthma morbidity and should not be used for this purpose. In this report we present a methodology for summarizing" episodes" of hospital-based care for asthma among the members of a large health maintenance organization (HMO). We then use these episodes to examine 2Q-yr trends in the utilization of hospitalbased services for asthma. By" hospital-based" care we mean both
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儿童支气管哮喘急性加重与下午天气变化有关。
DOI：
--
发表时间：
1991
期刊：
American Review of Respiratory Disease
影响因子：
--
作者：
S. Beer;Y. Kannai;M. Waron
通讯作者：
M. Waron
肥胖症护理和费用的情景方法
影响因子：
2.3
作者：
R. Johnson;T. Vogt;R. Penn
通讯作者：
R. Penn
描述医疗护理的情节。
DOI：
10.2105/ajph.57.3.401
发表时间：
1967
期刊：
American journal of public health and the nation's health
影响因子：
--
作者：
J. Solon;J. Feeney;S. H. Jones;R. D. Rigg;C. Sheps
通讯作者：
C. Sheps
影响因子：
10
作者：
ANDERSON, HR
通讯作者：
ANDERSON, HR
消费者对健康维护组织的满意度。
影响因子：
5
作者：
C. Pope
通讯作者：
C. Pope