Harish Z, Bregante A C, Morgan C, Fann C S, Callaghan C M, Witt M A, Levinson K A, Caspe W B
Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, NY, USA.
Ann Allergy Asthma Immunol. 2001 Feb;86(2):185-9. doi: 10.1016/S1081-1206(10)62689-0.
To evaluate the efficacy of a comprehensive asthma program on emergency department (ED) visits and hospital admission rates in an inner-city pediatric population.
A12-month prospective randomized trial.
Three hundred asthma patients, ages 2 to 17 years, were recruited and randomized in an inner-city pediatric ED, to obtain asthma care in a specialty clinic or to continue receiving care by other health resources. The specialty clinic provided intensive medical and environmental control, education, close monitoring, and 24-hour availability. For the prospective study, monthly questionnaires were sent to the caregivers of these children to evaluate use of hospital facilities for asthma care. For the retrospective study, use of hospital resources by the study participants was analyzed using a hospital database.
One hundred twenty-nine patients (60 in the treatment group and 69 in the control group) were included in the final analysis. Asthma severity index was significantly higher for the patients in the treatment versus the control group (35% versus 16.2%, P = .05). Fewer patients in the treatment group visited the ED at least once during the first study year, 32 versus 46, (P = .11), and they made fewer visits, 73 versus 269. The mean number of ED visits of the patients who used the ED was 0.1 versus 0.326 for the control group (P = .01). There were also fewer admissions in the treatment group, 22 versus 29 (P < .59). The 53 patients remaining in the treatment group in the second study year made fewer visits to the ED versus the control group (P < .03). In comparison to the first year, fewer patients in the treatment group visited the ED or were hospitalized in the second year (P = .007 and P = .04, respectively).
A comprehensive asthma care program is efficacious in reducing hospital utilization.
评估一项综合性哮喘项目对市中心城区儿科人群急诊就诊率和住院率的疗效。
为期12个月的前瞻性随机试验。
招募了300名年龄在2至17岁的哮喘患者，在市中心城区的儿科急诊室将他们随机分组，一组在专科诊所接受哮喘治疗，另一组继续通过其他医疗资源接受治疗。专科诊所提供强化医疗和环境控制、教育、密切监测以及24小时服务。在前瞻性研究中，每月向这些儿童的照料者发送问卷，以评估医院设施用于哮喘治疗的情况。在回顾性研究中，利用医院数据库分析研究参与者对医院资源的使用情况。
最终分析纳入了129名患者（治疗组60名，对照组69名）。治疗组患者的哮喘严重指数显著高于对照组（35%对16.2%，P = 0.05）。在第一个研究年度，治疗组中至少就诊一次的患者较少，分别为32例和46例（P = 0.11），且就诊次数也较少，分别为73次和269次。使用急诊室的患者平均急诊就诊次数治疗组为0.1次，对照组为0.326次（P = 0.01）。治疗组的住院人数也较少，分别为22例和29例（P < 0.59）。在第二个研究年度，治疗组中剩余的53名患者急诊就诊次数少于对照组（P < 0.03）。与第一年相比，治疗组中在第二年就诊于急诊室或住院的患者较少（分别为P = 0.007和P = 0.04）。
一项综合性哮喘护理项目在降低医院利用率方面是有效的。
