Department Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
Pediatrics. 2012 Feb;129(2):e325-32. doi: 10.1542/peds.2010-3302. Epub 2012 Jan 16.
To test the hypothesis that an association exists between process and outcome measures of the quality of acute asthma care provided to children in the emergency department.
Investigators at 14 US sites prospectively enrolled consecutive children 2 to 17 years of age presenting to the emergency department with acute asthma. In models adjusted for variables commonly associated with the quality of acute asthma care, we measured the association between 7 measures of concordance with national asthma guideline-recommended processes and 2 outcomes. Specifically, we modeled the association between 5 receipt/nonreceipt process measures and successful discharge and the association between 2 timeliness measures and admission.
In this cohort of 1426 patients, 62% were discharged without relapse or ongoing symptoms (successful discharge), 15% were discharged with relapse or ongoing symptoms, and 24% were admitted. The composite score for receipt of all 5 receipt/nonreceipt process measures was 84%, and for timeliness measures, 57% receive a timely corticosteroid and 92% a timely β-agonist. Our adjusted models showed no association between process and outcome measures, with 1 exception: timely β-agonist administration was associated with admission, likely reflecting confounding by severity rather than a true process-outcome association.
We found no clinically significant association between process and outcome quality measures in the delivery of asthma-related care to children in a multicenter study. Although the quality of emergency department care does not predict successful discharge, other factors, such as outpatient care, may better predict outcomes.
验证以下假设，即在为急诊科急性哮喘患儿提供的护理质量的过程和结果评估中，存在着某种关联。
14 个美国研究点的调查员前瞻性地招募了 1426 名年龄在 2 至 17 岁、因急性哮喘发作而到急诊科就诊的连续患儿。在调整了与急性哮喘护理质量普遍相关的变量后，我们衡量了 7 项与国家哮喘指南推荐的流程相符的衡量标准与 2 项结果之间的关联。具体来说，我们对以下两种关系进行了建模：一是 5 项接收/未接收流程测量与成功出院之间的关联；二是 2 项及时性测量与入院之间的关联。
在该队列的 1426 名患者中，62%的患者无复发或持续症状（成功出院），15%的患者出院时有复发或持续症状，24%的患者入院。所有 5 项接收/未接收流程测量的综合得分是 84%，而及时性测量中，57%的患者及时接受了皮质激素治疗，92%的患者及时接受了β-激动剂治疗。我们的调整模型显示，过程和结果测量之间没有关联，只有一个例外：及时使用β-激动剂与入院相关，这可能反映了严重程度的混杂因素，而不是真正的过程-结果关联。
我们在一项多中心研究中未发现哮喘相关护理中过程与结果质量衡量之间存在显著的临床关联。虽然急诊科护理质量并不能预测成功出院，但其他因素（如门诊护理）可能更好地预测结果。
