Bratton D L, Price M, Gavin L, Glenn K, Brenner M, Gelfand E W, Klinnert M D
Department of Pediatrics, National Jewish Medical and Research Center and University of Colorado Health Science Center, 1400 Jackson St., Denver, CO 80206, USA.
Pediatr Pulmonol. 2001 Mar;31(3):177-89. doi: 10.1002/ppul.1027.
For patients whose asthma remains in poor control necessitating high utilization of medical services, a referral to a specialized "center of excellence" is often considered. A decade ago, we evaluated our pediatric asthma program of long-term hospitalization (median stay of 75 days) and found significant decreases in subjects' medical utilization following this intervention. In an effort to contain treatment costs, the former program was markedly altered to one of abbreviated stay with emphasis on family management of asthma. The purpose of the present study was to determine the outcome of children treated in the revised program with regard to disease severity, quality of life, and subsequent utilization of medical resources. Children with severe asthma who were admitted to the program and fulfilled study criteria were consecutively enrolled. Data was obtained concerning disease characteristics, treatment, and quality of life at admission, and at 1 and 2 years following discharge. Medical records for the year prior to program admission and for the 2 years following discharge were coded for medical care encounters. Ninety-eight children, aged 9 months to 18 years (mean age, 10.9 years), were enrolled. They participated in the program for a mean of 15.6 ( +/- 8 SD), median of 15.0, and range of 2-51 treatment days. The group showed significant improvement (P < 0.0001) from admission to 1- and 2-year follow-up in median corticosteroid use, asthma functional severity, perceived competence in asthma management, and quality of life for both caregiver and child. Medical record data showed significant improvement (P < 0.0001) at both 1- and 2-year follow-up in median number of corticosteroid bursts, emergency department visits, hospital days, and overall utilization of medical care encounters. A median total medical encounter cost/patient of $16,250 ($6,972-$25,714 interquartile range (IQR)) for the year prior to program participation was reduced to $1,902 ($505-$6,524 IQR) at 1-year and $690 ($185-$3,550 IQR) at 2- year follow-up (P < 0.0001). We conclude that multidisciplinary care in a short-term, outpatient, day treatment program can significantly contribute to improvement in asthma severity, quality of life, and reduction in healthcare costs.
对于哮喘控制不佳、需要频繁使用医疗服务的患者，通常会考虑将其转诊至专门的“卓越中心”。十年前，我们评估了我们的儿科哮喘长期住院项目（中位住院时间为75天），发现干预后受试者的医疗服务使用量显著下降。为了控制治疗成本，之前的项目被大幅调整为短期住院项目，重点是哮喘的家庭管理。本研究的目的是确定在修订后的项目中接受治疗的儿童在疾病严重程度、生活质量和后续医疗资源使用方面的结果。连续纳入了符合研究标准且因重度哮喘入院的儿童。收集了关于入院时、出院后1年和2年的疾病特征、治疗情况和生活质量的数据。对项目入院前一年和出院后两年的医疗记录进行编码，以统计医疗护理接触情况。共纳入98名年龄在9个月至18岁（平均年龄10.9岁）的儿童。他们参与项目的平均时间为15.6（±8标准差）天，中位数为15.0天，范围为2至51个治疗日。从入院到1年和2年随访，该组在皮质类固醇使用中位数、哮喘功能严重程度、哮喘管理的自我效能感以及照顾者和儿童的生活质量方面均有显著改善（P<0.0001）。医疗记录数据显示，在1年和2年随访时，皮质类固醇冲击治疗的中位数、急诊科就诊次数、住院天数以及医疗护理接触的总体使用量均有显著改善（P<0.0001）。参与项目前一年每位患者的医疗接触总费用中位数为16,250美元（四分位间距（IQR）为6,972 - 25,714美元），在1年随访时降至1,902美元（IQR为505 - 6,524美元），在2年随访时降至690美元（IQR为185 - 3,550美元）（P<0.0001）。我们得出结论，短期门诊日间治疗项目中的多学科护理可显著改善哮喘严重程度、提高生活质量并降低医疗成本。
