Apter A J, Van Hoof T J, Sherwin T E, Casey B A, Petrillo M K, Meehan T P
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
Ann Allergy Asthma Immunol. 2001 Feb;86(2):211-8. doi: 10.1016/S1081-1206(10)62693-2.
Many states have enrolled Medicaid beneficiaries in managed care organizations (MCOs). Few assessments of the quality of asthma care provided by these new programs are available.
To describe the quality of care provided to asthmatic Medicaid children enrolled in MCOs.
For this cross-sectional survey, a chart abstraction tool was developed to evaluate fulfillment of key performance measures chosen from a national guideline for asthma diagnosis and management. These measures were prescription of an inhaled anti-inflammatory medication, accomplishment of patient education, evaluation of exposure to environmental triggers of asthma, and administration of influenza vaccination. From State of Connecticut administrative databases, a random sampling of Medicaid children, ages 5 to 18 years, enrolled in four MCOs was selected. Chart entries from July 1, 1996 to June 30, 1997 were reviewed using the abstraction tool. Accomplishment of performance measures was evaluated for the total sample and for children who were high utilizers of medical services (at least one ED visit or hospitalization during the study period).
For 80 high utilizers among 315 children, completion of performance measures was suboptimal: 46% were prescribed inhaled steroids; an action plan was outlined for 43%; evaluation of patient or family tobacco use was documented for 56%; evaluation of the presence of a pet for 43% or mite exposure for 19%; and allergy skin testing or RAST was accomplished for 15%.
This information suggests that opportunities exist to improve the quality of care for these children.
许多州已将医疗补助受益人纳入管理式医疗组织（MCO）。针对这些新项目所提供的哮喘护理质量的评估很少。
描述纳入MCO的哮喘医疗补助儿童所接受的护理质量。
对于这项横断面调查，开发了一种图表摘要工具，以评估从哮喘诊断和管理国家指南中选取的关键绩效指标的完成情况。这些指标包括吸入性抗炎药物的处方、患者教育的完成情况、对哮喘环境触发因素暴露的评估以及流感疫苗接种。从康涅狄格州行政数据库中，随机抽取了年龄在5至18岁、纳入四个MCO的医疗补助儿童。使用摘要工具对1996年7月1日至1997年6月30日的图表记录进行审查。对总样本以及医疗服务高利用率儿童（研究期间至少有一次急诊就诊或住院）的绩效指标完成情况进行评估。
在315名儿童中的80名高利用率儿童中，绩效指标的完成情况不理想：46%的儿童开具了吸入性类固醇药物；43%的儿童制定了行动计划；56%的儿童记录了对患者或家庭吸烟情况的评估；43%的儿童评估了是否有宠物，19%的儿童评估了螨虫暴露情况；15%的儿童完成了过敏皮肤试验或放射变应原吸附试验。
这些信息表明有机会改善这些儿童的护理质量。
