PATIENT OUTCOMES WITH ANTIBIOTIC THERAPY OF LYME DISEASE

莱姆疏螺旋体病(莱姆病)是世界上第二大新发疾病，也是世界上最严重的 在美国，常见的病媒传播疾病是由感染 伯氏疏螺旋体。在马里兰州，得克萨斯州正在迅速蔓延 发病率还在增加，报告的病例每年翻一番。 感染会引起典型的皮疹和类似流感的症状， 慢性和复发性关节炎、心脏炎和神经异常。 肝豆状核变性的诊断和治疗，尤其是肝纤维化的治疗 慢性期，仍然是不确定和有争议的。这个项目 建议通过以下方式提高肝病患者的护理质量 研究变异导致的患者结局的差异 在抗生素治疗中。不适当的实践模式将是 确定和教育干预措施，以改进治疗做法 将会被评估。 使用电话采访报告医生和所有LB病例 在1993-1997年间向马里兰州卫生部报告，我们将 获取有关抗生素处方、患者依从性和 药物不良反应与临床反应不同 治疗迁延性红斑(EM)、莱姆性关节炎和其他淋巴组织病的方案 综合症。要衡量的结果是：疾病的改善或治愈 以及并发症的预防。变量是病人，疾病- (例如，确诊或未确诊病例、疾病阶段、疾病 综合症)和与治疗相关的(例如，药物、药物组、剂量、长度 和治疗路线)。在头3年里，估计有1200到 1600例肝豆状核变性患者将被纳入研究，并随访3年。 除了简单的列联表分析之外，多个线性和 将使用Logistic回归来控制混杂因素的影响 在计算风险和相对风险时保持不变。 在第4年和第5年期间，将进行两次医生培训干预 评估：全区干预将比较以下方面的产出 在该州部分地区执业的医生经常收到邮件， 与在另一个地方练习的人一起讲课并提供一条LB“热线” 没有这些的地区。训练曝光。此外，一个随机化的 研究将比较单一干预措施对一半患者的影响 头3年有800至1,000名医生报告了肺结核病例 剩下的400到500美元。将评估这两种干预措施的效果。 通过对临床实践模式的观察，以及通过前期和 随机化研究中的终止试验。最后，算法将是 旨在帮助马里兰州的医生管理患者 疑似路易斯安那州。

Lyme borreliosis (LB), the 2nd most important emerging disease and most common vector-borne disease in the USA, is caused by infection with the spirochete, Borrelia burgdorferi. In Maryland, LB is spreading rapidly and increasing in incidence with reported cases doubling each year. Infection causes a characteristic rash and "flu-like" symptoms and chronic and recurrent arthritis, carditis and neurological abnormalities. LB is difficult to diagnose and it's treatment, particularly therapy of the chronic stages, remains uncertain and controversial. This project proposes to improve the quality of care in patients with LB by investigating differences in patient outcomes resulting from variations in antibiotic therapy. Inappropriate practice patterns will be identified and educational interventions to improve treatment practices will be evaluated. Using telephone interviews with reporting physicians and all LB cases reported to the Maryland Department of Health from 1993-1997, we will obtain information on antibiotics prescribed, patient compliance and adverse reactions to the drugs and clinical responses to different regimens for treating erythema migrans (EM), Lyme arthritis and other LB syndromes. Outcomes to be measured are: improvement or cure of illness and prevention of complications. The variables are patient-, disease- (e.g., confirmed or unconfirmed cases, stage of disease, disease syndrome) and treatment- related (e.g., drug, drug group, dose, length and route of therapy). During the first 3 years an estimated 1,200 to 1,600 cases of LB will be admitted to the study and followed for 3 years. In addition to simple contingency table analysis, multiple linear and logistic regression will be employed to hold the effects of confounders constant while computing risks and relative risks. During the 4th and 5th years two physician training interventions will be evaluated: the area-wide intervention will compare outputs from physicians practicing in part of the state who receive frequent mailings, lectures and provision of a LB "hotline" with those practicing in another area not having these. training exposures. In addition, a randomized study will compare the effects of a single intervention on half of the 800-to-1,000 physicians reporting LB cases during the first 3 years with the remaining 400-to-500. Effects of both interventions will be assessed by observations on clinical practice patterns and by pre- and termination-testing in the randomized study. Finally, algorithms will be constructed to assist Maryland physicians managing patients with suspected LB.