Department of Allergy, Kaiser Permanente Medical Center, 7060 Clairemont Mesa Blvd, San Diego, CA 92111, USA.
Am J Manag Care. 2010 May;16(5):327-33.
To compare the relationship of surrogate markers of asthma control to subsequent asthma exacerbations.
Retrospective cohort.
Administrative data were used to identify patients who met the Healthcare Effectiveness Data and Information Set (HEDIS) criteria for persistent asthma in 2006 and 2007. The following potential surrogate markers of asthma control assessed in 2007 were compared for their ability to predict asthma exacerbations in 2008 (defined as oral corticosteroid dispensing or an asthma hospitalization or emergency department visit): dispensing of any controller, unweighted medication ratio (the ratio of controller to total medication), weighted medication ratio, and the number of short-acting beta-agonist (SABA) canisters dispensed. Weighted medication ratios were weighted for controller potency and for doses per container.
Meeting the HEDIS criteria for persistent asthma were 8634 patients (60.5% female) aged 18 to 56 years (mean age, 42.7 years), of whom 6.5% experienced emergency hospital care and 27.3% received oral corticosteroids in 2008. The largest effect size for predicting reduced emergency hospital care was for the number of SABA canisters dispensed (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.40-0.60), followed by the unweighted medication ratio (OR, 0.54; 95% CI, 0.40-0.72), and then the weighted medication ratio (OR, 0.57; 95% CI, 0.45-0.73). Dispensing of any controller was associated with a nonsignificant increased risk of emergency hospital care (OR, 1.41; 95% CI, 0.95-2.09).
The number of SABA canisters dispensed is most strongly related to improved asthma outcomes, followed by the unweighted medication ratio; dispensing of any controller is least related. Health plans can use the number of SABA canisters dispensed and the unweighted medication ratio for asthma population management or for provider quality-of-care assessment to reduce asthma exacerbations, which exact a high economic and humanistic cost.
比较哮喘控制的替代标志物与随后哮喘加重的关系。
回顾性队列研究。
利用行政数据，确定 2006 年和 2007 年符合医疗保健效果数据和信息集（HEDIS）持续性哮喘标准的患者。在 2007 年评估了以下可能的哮喘控制替代标志物，以比较其预测 2008 年哮喘加重的能力（定义为口服皮质类固醇配药或哮喘住院或急诊就诊）：任何控制器的配药、未加权药物比（控制器与总药物的比值）、加权药物比和短效β-激动剂（SABA）罐的配药量。加权药物比根据控制器效力和每容器剂量进行加权。
符合 HEDIS 持续性哮喘标准的 8634 例患者（60.5%为女性）年龄为 18 至 56 岁（平均年龄为 42.7 岁），其中 6.5%在 2008 年接受了急诊治疗，27.3%接受了口服皮质类固醇治疗。预测减少急诊治疗的效果最大的是 SABA 罐的配药数量（比值比[OR]，0.49；95%置信区间[CI]，0.40-0.60），其次是未加权药物比（OR，0.54；95% CI，0.40-0.72），然后是加权药物比（OR，0.57；95% CI，0.45-0.73）。任何控制器的配药与急诊治疗的风险增加无关（OR，1.41；95% CI，0.95-2.09）。
SABA 罐的配药数量与改善哮喘结果最密切相关，其次是未加权药物比；任何控制器的配药与改善哮喘结果最不相关。健康计划可以使用 SABA 罐的配药数量和未加权药物比进行哮喘人群管理或提供者医疗质量评估，以减少哮喘加重，这会带来高昂的经济和人文成本。
