Cloutier Michelle M, Wakefield Dorothy B, Sangeloty-Higgins Pamela, Delaronde Steven, Hall Charles B
Asthma Center, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106, USA.
Pediatrics. 2006 Nov;118(5):1880-7. doi: 10.1542/peds.2006-1019.
We sought to examine whether pediatric clinicians in private, non-health maintenance organization practices could implement the national asthma guidelines and whether, when implemented, these guidelines would decrease medical services utilization and improve asthma care for children.
A trial of a disease management program (Easy Breathing II) involving 20 private pediatric practices in the greater Hartford, Connecticut area was conducted between January 1, 2001, and December 31, 2003. Demographic data on participating practitioners and patients were obtained from questionnaires. Medical services utilization data from claims were obtained from ConnectiCare, a regional managed care organization.
Of the 16750 children enrolled in Easy Breathing II, 2458 were enrolled in ConnectiCare and 490 had asthma. Inhaled corticosteroid use increased in the community overall during the study period. After enrollment in Easy Breathing II, with adjustment for age, gender, ethnicity, asthma severity, season, and calendar year, children with persistent asthma experienced an additional 47% increase in inhaled corticosteroid use, a 56% reduction in outpatient visits, and a 91% decrease in emergency department visits for treatment of asthma. Adherence to national asthma guidelines for prescribing inhaled corticosteroids was 95%. Seventeen of the 20 practices are still using Easy Breathing, 5 years after program implementation.
Pediatric primary care clinicians in private practice settings can implement an asthma management program patterned after the national asthma guidelines. When implemented, this program is successful in reducing medical services utilization for children with asthma. Just as differences in patterns of medical services utilization exist in private practices, compared with urban clinics, the impact of disease management on medical services utilization differs in private practices, compared with urban clinics.
我们试图研究在非健康维护组织的私人诊所工作的儿科临床医生能否实施国家哮喘指南，以及这些指南实施后是否会减少医疗服务的使用，并改善儿童哮喘护理。
2001年1月1日至2003年12月31日期间，在康涅狄格州大哈特福德地区对20家私人儿科诊所进行了一项疾病管理项目（轻松呼吸II）试验。参与的从业者和患者的人口统计学数据通过问卷调查获得。索赔的医疗服务使用数据来自区域管理式医疗组织康涅狄格护理公司。
在参加轻松呼吸II的16750名儿童中，2458名参加了康涅狄格护理公司，其中490名患有哮喘。在研究期间，社区中吸入性糖皮质激素的使用总体有所增加。在参加轻松呼吸II后，在对年龄、性别、种族、哮喘严重程度、季节和日历年进行调整后，持续性哮喘儿童吸入性糖皮质激素的使用额外增加了47%，门诊就诊次数减少了56%，因哮喘治疗的急诊就诊次数减少了91%。吸入性糖皮质激素处方遵循国家哮喘指南的比例为95%。项目实施5年后，20家诊所中有17家仍在使用轻松呼吸项目。
私人执业环境中的儿科初级保健临床医生可以实施一项以国家哮喘指南为蓝本的哮喘管理项目。实施该项目后，成功减少了哮喘儿童的医疗服务使用。正如与城市诊所相比，私人诊所的医疗服务使用模式存在差异一样，与城市诊所相比，疾病管理对私人诊所医疗服务使用的影响也有所不同。
