Medical home characteristics and asthma control: a prospective, observational cohort study protocol.
Medical home characteristics and asthma control: a prospective, observational cohort study protocol.
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DOI：
10.13063/2327-9214.1032
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Schilling LM
中科院分区：
文献类型：
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作者：
Sills MR;Kwan BM;Yawn BP;Sauer BC;Fairclough DL;Federico MJ;Juarez-Colunga E;Schilling LM
本文描述了一项观察性比较有效性研究的方法，该研究旨在检验在安全网初级保健实践中接受护理的儿童和成人中实践水平医疗家庭特征与哮喘控制之间的关联。这是一项前瞻性、纵向队列研究，利用调查方法和对现有结构化临床、管理和索赔数据的二次分析。联邦翻译查询网络的可扩展架构（SAFTINet）是一个面向安全网络的、基于初级保健实践的研究网络，其联邦数据库包含电子健康记录（EHR）和医疗补助索赔数据。将纳入来自四家医疗机构50个实践的约20，000名患者的数据。使用聚类设计，控制潜在的混杂变量，将实践水平的医疗之家特征与患者水平的哮喘结局相关。将使用线性和非线性混合模型进行分析。研究开始于2012年7月1日。使用因果图理论方法指导协变量选择，以控制偏倚和混杂因素。这种设计的优势包括假设和方法的先验规范，在安全网实践中护理的哮喘患者的大样本，在实施医疗之家概念的现实世界的变化的研究，以及索赔数据，患者报告的数据，EHR的临床数据和实践水平的调查相结合的创新使用。我们使用理论，设计和分析解决因果推理的局限性。
This paper describes the methods for an observational comparative effectiveness research study designed to test the association between practice-level medical home characteristics and asthma control in children and adults receiving care in safety-net primary care practices. This is a prospective, longitudinal cohort study, utilizing survey methodologies and secondary analysis of existing structured clinical, administrative, and claims data. The Scalable Architecture for Federated Translational Inquiries Network (SAFTINet) is a safety net-oriented, primary care practice-based research network, with federated databases containing electronic health record (EHR) and Medicaid claims data. Data from approximately 20,000 patients from 50 practices in four healthcare organizations will be included. Practice-level medical home characteristics will be correlated with patient-level asthma outcomes, controlling for potential confounding variables, using a clustered design. Linear and non-linear mixed models will be used for analysis. Study inception was July 1, 2012. A causal graph theory approach was used to guide covariate selection to control for bias and confounding. Strengths of this design include a priori specification of hypotheses and methods, a large sample of patients with asthma cared for in safety-net practices, the study of real-world variations in the implementation of the medical home concept, and the innovative use of a combination of claims data, patient-reported data, clinical data from EHRs, and practice-level surveys. We address limitations in causal inference using theory, design and analysis.