Crain E F, Mortimer K M, Bauman L J, Kercsmar C M, Weiss K B, Wissow L, Mitchell H, Rotor D
Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA.
J Asthma. 1999;36(1):129-38. doi: 10.3109/02770909909065156.
The National Asthma Education and Prevention Program NAEPP Guidelines include recommendations for history-taking and discharge planning during an asthma visit, but there are no tools to measure performance. The objectives of this study were to define and operationalize key elements of history-taking and discharge planning, to develop a tool for measuring these elements, and to evaluate the quality of history-taking and discharge planning in the emergency department (ED) during visits for asthma using the new tool. Expert opinion and extensive literature review were used to develop a 13-item checklist containing items that should be documented during history-taking and provided during discharge planning for an ED visit for an acute asthma exacerbation by children. A convenience sample of 90 pediatric emergency medicine physicians and allergists rated each item in the checklist. The checklist was used to score audiotapes of asthma visits in the ED. Subjects were 154 parents of asthmatic children aged 4-9 years seeking care in nine inner-city EDs affiliated with asthma centers participating in the National Cooperative Inner-City Asthma Study and the physician/providers who delivered care. Seven of the 13 items on the checklist were rated as required to be performed by more than 90% of the allergist/pediatric emergency medicine physicians. Only 10% of the 154 visits included all seven of the highly rated items, whereas 19% of the visits included three or fewer. Only 7 of the 13 items (54%) were performed in more than 50% of the visits, and 4 items were performed in fewer than 25% of visits. Based on expert ratings, the checklist for measuring elements of history-taking and discharge planning during asthma visits appears to have considerable face validity. In the visits studied, the overall performance of these elements was low. Interventions to improve performance on the checklist might lead to improved care for children with asthma who frequent the ED.
国家哮喘教育与预防计划（NAEPP）指南包含了哮喘就诊期间病史采集和出院计划的建议，但没有衡量执行情况的工具。本研究的目的是定义并实施病史采集和出院计划的关键要素，开发一种用于衡量这些要素的工具，并使用该新工具评估急诊科（ED）哮喘就诊期间病史采集和出院计划的质量。通过专家意见和广泛的文献综述，制定了一份包含13个条目的清单，这些条目应在儿童急性哮喘加重的急诊科就诊病史采集期间记录，并在出院计划中提供。90名儿科急诊医学医生和过敏症专科医生组成的便利样本对清单中的每个条目进行了评分。该清单用于对急诊科哮喘就诊的录音进行评分。研究对象是在参与全国城市内部哮喘合作研究的哮喘中心所属的9个市中心急诊科寻求治疗的154名4至9岁哮喘儿童的家长以及提供治疗的医生/医护人员。清单上13个条目中的7条被超过90%的过敏症专科医生/儿科急诊医学医生评为必须执行的项目。在154次就诊中，只有10%的就诊包含了所有7个高评分项目，而19%的就诊包含3个或更少的此类项目。13个条目中只有7条（54%）在超过50%的就诊中被执行，4个条目在不到25%的就诊中被执行。根据专家评分，用于衡量哮喘就诊期间病史采集和出院计划要素的清单似乎具有相当高的表面效度。在所研究的就诊中，这些要素的总体执行情况较差。改善清单执行情况的干预措施可能会改善经常前往急诊科的哮喘儿童所接受的护理。
