Cabana Michael, Slish Kathryn K, Nan Bin, Leo Harvey, Bratton Susan L, Dombkowski Kevin J
Division of General Pediatrics, Department of Pediatrics, University of California, San Francisco, 3333 California Street, Laurel Heights Bldg 245, San Francisco, California 94143-0503, USA.
Pediatrics. 2006 Jul;118(1):e151-6. doi: 10.1542/peds.2005-2352. Epub 2006 Jun 12.
The National Heart, Lung and Blood Institute asthma guidelines recommend that children with asthma receive spirometry testing "at least every 1 to 2 years to assess the maintenance of airway function."
The purpose of this work was to describe: (1) how often children with asthma receive spirometry testing, (2) what factors are associated with receipt of spirometry testing, and (3) the impact of spirometry testing on subsequent emergency department visits for asthma.
We analyzed all pediatric asthma claims data from a university-based managed care organization for a 3-year period (January 2001 to December 2003). We included all of the continuously enrolled patients with active asthma between 7 and 21 years of age. Our outcomes of interest were the presence of > or = 1 claim for spirometry testing (Common Procedural Terminology 94010-6, 94060, 94070, or 94150) and the time to emergency department visit. We used multivariate logistic regression to determine factors associated with receipt of spirometry and survival analyses techniques to assess the association between receipt of spirometry with the likelihood of an emergency department asthma visit in the next year, controlling for patient age, gender, severity of illness, and type of insurance.
There were 2688 eligible children of whom 1509 (56%) were male, 324 (12%) had Medicaid insurance, and 624 (24%) had persistent asthma in the initial year. Of the 2688 children, only 612 (23%) had > or = 1 claim for spirometry testing during the study period. In all of the multivariate logistic analysis models, increased severity of illness was consistently associated with increased likelihood of receiving spirometry testing. Compared with patients without Medicaid insurance, children with Medicaid insurance were consistently less likely to receive spirometry testing. After adjusting for age, gender, severity, and insurance type, receipt of spirometry did not affect the likelihood of future emergency department asthma use.
Children with Medicaid insurance are less likely to receive spirometry testing. Reasons may be because of access to care, inadequate provider referral for testing, or patient preferences. Objective lung function tests, such as spirometry, are a potentially important component of monitoring chronic disease status. However, it is not clear whether spirometry testing by itself, completed every 1 to 2 years, helps prevent the likelihood of emergency department asthma visits. Compared with guideline recommendations, spirometry is underused; however, additional work is needed to understand how to best integrate such testing to improve asthma outcomes.
美国国立心肺血液研究所哮喘指南建议，哮喘患儿应“至少每1至2年接受一次肺功能测定，以评估气道功能的维持情况”。
本研究旨在描述：（1）哮喘患儿接受肺功能测定的频率；（2）与接受肺功能测定相关的因素；（3）肺功能测定对随后因哮喘前往急诊科就诊的影响。
我们分析了一家大学附属管理式医疗组织在3年期间（2001年1月至2003年12月）的所有儿科哮喘理赔数据。纳入所有年龄在7至21岁之间持续参保的活动性哮喘患者。我们感兴趣的结果是是否有≥1次肺功能测定理赔记录（通用程序术语94010 - 6、94060、94070或94150）以及前往急诊科就诊的时间。我们使用多变量逻辑回归来确定与接受肺功能测定相关的因素，并使用生存分析技术来评估接受肺功能测定与次年因哮喘前往急诊科就诊可能性之间的关联，同时控制患者年龄、性别、疾病严重程度和保险类型。
共有2688名符合条件的儿童，其中1509名（56%）为男性，324名（12%）拥有医疗补助保险，624名（占初始年份的24%）患有持续性哮喘。在这2688名儿童中，在研究期间只有612名（23%）有≥1次肺功能测定理赔记录。在所有多变量逻辑分析模型中，疾病严重程度增加始终与接受肺功能测定的可能性增加相关。与没有医疗补助保险的患者相比，拥有医疗补助保险的儿童接受肺功能测定的可能性始终较低。在调整年龄、性别、严重程度和保险类型后，接受肺功能测定并不影响未来因哮喘前往急诊科就诊的可能性。
拥有医疗补助保险的儿童接受肺功能测定的可能性较低。原因可能是获得医疗服务的机会、医生对检测的转诊不足或患者偏好。客观的肺功能测试，如肺功能测定，是监测慢性病状态的一个潜在重要组成部分。然而，尚不清楚每1至2年进行一次的肺功能测定本身是否有助于预防因哮喘前往急诊科就诊的可能性。与指南建议相比，肺功能测定的使用不足；然而，需要进一步开展工作以了解如何最好地整合此类检测以改善哮喘治疗效果。
