Effectiveness of emergency department asthma management strategies on return visits in children: A population-based study
Effectiveness of emergency department asthma management strategies on return visits in children: A population-based study
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DOI：
10.1542/peds.2007-0168
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发表时间：
2007-12-01
期刊：
影响因子：
8
通讯作者：
Anderson, Geoff
中科院分区：
文献类型：
--
作者：
Guttmann, Astrid;Zagorski, Brandon;Anderson, Geoff
背景。急诊科在哮喘患儿的护理中起着重要的作用。急诊科复诊率是衡量急性哮喘护理质量的一个指标。我们的目标是描述在急诊科治疗哮喘的儿童的特征，急诊科使用的资源和哮喘管理策略，以及它们对72小时内复诊的影响。设计，环境和病人。我们采用了一项基于人群的队列研究，纳入了加拿大安大略省所有152个急诊科的综合行政卫生和调查数据。我们研究了2003年4月至2005年3月期间因哮喘到急诊科就诊的所有2至17岁儿童。共有32996名儿童（占安大略省哮喘儿童的10%）至少到急诊科就诊1次，其中大多数（68.5%）被分类为高急性程度。绝大多数（152个急诊部门中的148个[97%]）报告使用至少1种哮喘管理策略，74%使用3种或更多。整体回访率为5.6%。考虑急诊科患者聚类并控制患者和急诊科特征的Logistic回归模型表明，预先打印的医嘱单和获得儿科医生咨询是与减少复诊显著相关的策略。采用这两种策略的11家急诊科（17%）的回访率为4.4%，而未采用这两种策略的95家急诊科（63%）的回访率为6.9%。急诊部门使用一系列策略来管理儿童哮喘。预先打印的处方单和获得儿科医生与复诊率的显著降低有关，更多的急诊科应考虑使用这些策略。
BACKGROUND. Emergency departments play an important role in the care of children with asthma. Emergency department return-visit rates provide a measure of the quality of acute asthma care.OBJECTIVE. Our goal was to describe the characteristics of children treated in emergency departments for asthma, the resources and asthma management strategies used by emergency departments, and their effect on return visits within 72 hours.DESIGN, SETTING, AND PATIENTS. We used a population-based cohort study that incorporated both comprehensive administrative heath and survey data from all 152 emergency departments in Ontario, Canada. We studied all 2- to 17-year-old children who had a visit to an emergency department for asthma from April 2003 to March 2005.RESULTS. A total of 32 996 children ( > 9% of children with asthma in Ontario) had at least 1 visit to an emergency department for the care of asthma, and most of these visits ( 68.5%) were triaged as high acuity. The vast majority ( 148 of 152 [ 97%]) of emergency departments reported using at least 1 asthma management strategy, and 74% used 3 or more. The overall return-visit rate was 5.6%. Logistic regression models that accounted for the clustering of patients in emergency departments and controlled for patient and emergency department characteristics indicated that preprinted order sheets and access to a pediatrician for consultation were strategies significantly associated with a reduction in return visits. The 11 ( 17%) emergency departments that used both of these strategies had return visit rates of 4.4% compared with 6.9% in the 95 ( 63%) that used neither strategy.CONCLUSIONS. Emergency departments use a range of strategies to manage asthma in children. Preprinted order sheets and access to pediatricians are associated with important reductions in return-visit rates, and more emergency departments should consider using these strategies.