安大略省哮喘区域差异研究：急诊科就诊率及其与住院率的关系。

The Ontario Asthma Regional Variation Study: emergency department visit rates and the relation to hospitalization rates.

作者信息

Lougheed M Diane, Garvey Nancy, Chapman Kenneth R, Cicutto Lisa, Dales Robert, Day Andrew G, Hopman Wilma M, Lam Miu, Sears Malcolm R, Szpiro Kim, To Teresa, Paterson Nigel A M

机构信息

Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada.

出版信息

Chest. 2006 Apr;129(4):909-17. doi: 10.1378/chest.129.4.909.

DOI:10.1378/chest.129.4.909

PMID:16608938

Abstract

BACKGROUND

Hospitalization rates for asthma vary more than threefold across regions of Ontario. It is not known whether this variation is primarily due to regional differences in the rate of emergency department (ED) visits or hospital admissions.

OBJECTIVE

To determine the variation in ED visit rates for asthma in Ontario, and the relation between ED visit rates and hospitalization rates.

DESIGN, SETTING, AND PATIENTS: We studied patients with an ED disposition diagnosis of asthma in a stratified sample of 16 hospitals (pediatric facilities, 13; adult facilities, 14) over a 1-year period. Pediatric patients were defined as those patients who were </= 19 years of age.

MEASUREMENTS

Direct age-standardized and sex-standardized ED visit and hospitalization rates, and the percentages of patients presenting to EDs and subsequently admitted to the hospital were calculated for each site. High/low ratios (ie, extremal quotients [EQ]), weighted coefficients of variation (CVs), and the systematic component of variation (SCV) were used to summarize the variation among hospitals.

RESULTS

The total number of ED visits for asthma at participating sites was 12,518 (7,825 children and 4,693 adults). A total of 847 children (10.8%) and 322 adults (6.9%) were admitted to the hospital. Age-standardized and sex-standardized ED visit rates ranged from 8.7 to 25.2 per 1,000 population for children (EQ, 2.9; CV, 30.9%; SCV, 173; p < 0.001) and 1.7 to 10.1 per 1,000 population for adults (EQ, 5.9; CV, 52.9; SCV, 445; p < 0.001). The proportion of pediatric and adult ED visits resulting in admission to the hospital varied significantly by site (p < 0.001) and was inversely related to ED visit rates in children (p < 0.001) but not in adults. ED visit rates were related to hospitalization rates in children (p = 0.042) and adults (p < 0.0001), but only accounted for 4% and 27%, respectively, of the variation in hospitalization rates.

CONCLUSION

Hospitalization rates for asthma in Ontario are primarily influenced by the variation in the percentage of ED visitors admitted to the hospital rather than the ED visit rate.

摘要

背景

安大略省各地区哮喘住院率相差三倍多。目前尚不清楚这种差异主要是由于急诊就诊率还是住院率的地区差异所致。

目的

确定安大略省哮喘急诊就诊率的差异，以及急诊就诊率与住院率之间的关系。

设计、地点和患者：我们在16家医院（13家儿科机构，14家成人机构）的分层样本中，对1年内有哮喘急诊诊断的患者进行了研究。儿科患者定义为年龄≤19岁的患者。

测量

计算每个地点直接年龄标准化和性别标准化的急诊就诊率和住院率，以及到急诊就诊并随后住院的患者百分比。使用高/低比率（即极值商[EQ]）、加权变异系数（CV）和变异的系统成分（SCV）来总结医院之间的差异。

结果

参与研究地点哮喘急诊就诊总数为12518例（儿童7825例，成人4693例）。共有847名儿童（10.8%）和322名成人（6.9%）住院。年龄标准化和性别标准化的急诊就诊率，儿童为每1000人8.7至25.2例（EQ，2.9；CV，30.9%；SCV，173；p<0.001），成人为每1000人1.7至10.1例（EQ，5.9；CV，52.9；SCV，445；p<0.001）。儿科和成人急诊就诊后住院的比例因地点而异（p<0.001），且与儿童急诊就诊率呈负相关（p<0.001），但与成人无关。急诊就诊率与儿童（p = 0.042）和成人（p<0.0001）的住院率相关，但分别仅占住院率差异的4%和27%。