Erickson Sara, Tolstykh Irina, Selby Joe V, Mendoza Guillermo, Iribarren Carlos, Eisner Mark D
Department of Medicine, University of California, San Fransisco, 350 Parnassus Avenue, Ste 609, San Francisco, CA 94117, USA.
Health Serv Res. 2005 Oct;40(5 Pt 1):1443-65. doi: 10.1111/j.1475-6773.2005.00410.x.
To evaluate the longitudinal impact of asthma specialist care on the risk of emergency department (ED) visits and hospitalization for asthma.
DATA SOURCES/STUDY SETTING: A prospective cohort study using both telephone survey and computerized utilization data.
We recruited a prospective cohort of 4,742 adult members of a closed panel managed care organization who were hospitalized for asthma (the "baseline hospitalization").
DATA COLLECTION/EXTRACTION METHODS: Visits to asthma specialists were ascertained from computerized utilization databases. Specialist visits after baseline hospitalization were defined as time-dependent covariates. An alternative analysis defined specialist visits during the year preceding baseline hospitalization. A subcohort of 596 subjects completed telephone interviews.
Compared with subjects who received no specialist visits after baseline hospitalization, treatment by allergists (hazard ratio (HR) 1.04; 95 percent confidence interval (CI) 0.87-1.26) or pulmonologists (HR 0.92; 95 percent CI 0.71-1.19) was not associated with a reduction in the risk of future ED visits for asthma in the entire cohort, controlling for age, sex, race, recent asthma medication dispensing, and pharmacy benefits status. There was also no association between allergist visits and the risk of subsequent hospitalizations for asthma (HR 0.93; 95 percent CI 0.75-1.14). In contrast, visits to pulmonologists (HR 0.74; 95 percent CI 0.55-0.99) were related to a reduced risk of rehospitalization.
Pulmonary specialist visits appeared to reduce the risk of hospitalization for asthma, whereas asthma specialist visits did not reduce the risk of ED visits. In the context of comprehensive prepaid health care, the benefit of specialist care was modest.
评估哮喘专科护理对哮喘患者急诊就诊风险和住院风险的长期影响。
数据来源/研究背景：一项前瞻性队列研究，采用电话调查和计算机化利用数据。
我们招募了一个前瞻性队列，其中包括4742名封闭式管理医疗组织的成年成员，他们因哮喘住院（“基线住院”）。
数据收集/提取方法：从计算机化利用数据库中确定哮喘专科就诊情况。基线住院后的专科就诊被定义为随时间变化的协变量。另一种分析定义了基线住院前一年的专科就诊情况。一个由596名受试者组成的亚队列完成了电话访谈。
与基线住院后未接受专科就诊的受试者相比，在控制年龄、性别、种族、近期哮喘药物配药和药房福利状况后，过敏症专科医生（风险比（HR）1.04；95%置信区间（CI）0.87 - 1.26）或肺科医生（HR 0.92；95%CI 0.71 - 1.19）的治疗与整个队列中未来哮喘急诊就诊风险的降低无关。过敏症专科医生就诊与随后哮喘住院风险之间也没有关联（HR 0.93；95%CI 0.75 - 1.14）。相比之下，肺科医生就诊（HR 0.74；95%CI 0.55 - 0.99）与再住院风险降低有关。
肺科专科就诊似乎降低了哮喘住院风险，而哮喘专科就诊并未降低急诊就诊风险。在综合预付医疗保健的背景下，专科护理的益处不大。
