Slack R, Bucknall C E
GGHB Clinical Audit, Glasgow, UK.
Qual Health Care. 1997 Dec;6(4):194-8. doi: 10.1136/qshc.6.4.194.
To test the hypothesis that sustained differences in readmission rate for acute asthma were associated with variations in clinical practice.
Data were collected by retrospective review of case notes, using the criteria recommended by the British Thoracic Society.
Two city National Health Service (NHS) hospitals that had recorded a sustained difference in readmission rate for acute asthma.
A random sample of 50 from each hospital, selected from all 16-44 year old patients discharged in 1992 with acute asthma (ninth revision of the international classification of diseases (ICD-9) 493).
Hospital A had a lower readmission rate than hospital B. The sample groups were similar for age, sex, deprivation of area of residence, and severity of episode. Systemic corticosteroids were given early more often (p = 0.02) and oral corticosteroids were prescribed at discharge more often (p = 0.04) in hospital A. When a short course of oral corticosteroids was prescribed the duration stated was longer (p = 0.02) and inhaled corticosteroids were started or the dose increased more often (p = 0.02) in hospital A.
These results support the hypothesis that differences in readmission rates for acute asthma are associated with variations in clinical practice. Sustained variation in readmission rates is an outcome of health care, for acute asthma. The findings also support audit of the process of hospital asthma care as a proxy for outcome.
检验急性哮喘再入院率持续存在差异与临床实践差异相关这一假设。
采用回顾性病例记录审查的方式收集数据，使用英国胸科学会推荐的标准。
两家城市国民健康服务（NHS）医院，这两家医院记录的急性哮喘再入院率存在持续差异。
从每家医院随机抽取50例样本，选取的是1992年出院的所有16 - 44岁急性哮喘患者（国际疾病分类第九版（ICD - 9）493）。
医院A的再入院率低于医院B。样本组在年龄、性别、居住地区贫困程度和发作严重程度方面相似。医院A更常早期给予全身用糖皮质激素（p = 0.02），且出院时更常开具口服糖皮质激素（p = 0.04）。当开具短期口服糖皮质激素时，医院A规定的疗程更长（p = 0.02），且更常开始使用吸入性糖皮质激素或增加其剂量（p = 0.02）。
这些结果支持急性哮喘再入院率差异与临床实践差异相关这一假设。急性哮喘再入院率的持续差异是医疗保健的一个结果。这些发现还支持对医院哮喘护理过程进行审核作为结果的替代指标。
