Johnson K B, Blaisdell C J, Walker A, Eggleston P
Division of General Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-3144, USA.
Pediatrics. 2000 Nov;106(5):1006-12.
Clinical pathways for asthma are tools that have the potential to improve compliance with nationally recognized management guidelines, but their effect on patient outcomes has not been documented.
To determine the effect of an asthma clinical pathway on patients' length of stay, use of nebulized beta-agonist therapy while hospitalized, and use of acute care clinics for 2 weeks after discharge.
DESIGN/METHODS: The study was a randomized, controlled trial. Patients between the ages of 2 and 18 years admitted with an asthma exacerbation and not under the care of an asthma specialist were eligible for the study. Patients were randomized either to a conventional ward (control group) or to a ward using the clinical pathway (intervention group). For 2 weeks after discharge, we collected data to determine whether patients visited a health care provider for worsening asthma.
One hundred ten patients (26%) were enrolled. Control and intervention groups had similar demographic and asthma severity profiles. The intervention group had an average length of stay 13 hours shorter than did the control group. In addition, at every dosing interval, the intervention group received less nebulized beta-agonist therapy. There were no deaths in either group.
A clinical pathway for inpatient asthma decreased the length of stay and beta-agonist medication use with no adverse outcomes or increased acute-care encounters through 2 weeks after discharge.
哮喘临床路径是有可能提高对国家认可的管理指南依从性的工具，但它们对患者预后的影响尚无文献记载。
确定哮喘临床路径对患者住院时间、住院期间雾化β受体激动剂治疗的使用情况以及出院后2周内急性护理诊所就诊情况的影响。
设计/方法：该研究为随机对照试验。年龄在2至18岁之间因哮喘急性发作入院且未接受哮喘专科医生治疗的患者符合研究条件。患者被随机分为常规病房（对照组）或采用临床路径的病房（干预组）。出院后2周内，我们收集数据以确定患者是否因哮喘恶化就诊于医疗服务提供者。
110名患者（26%）入组。对照组和干预组的人口统计学和哮喘严重程度特征相似。干预组的平均住院时间比对照组短13小时。此外，在每个给药间隔，干预组接受的雾化β受体激动剂治疗较少。两组均无死亡病例。
住院哮喘临床路径缩短了住院时间和β受体激动剂药物的使用，在出院后2周内无不良后果或增加急性护理就诊次数。
