Liberman Danica B, Shelef Deborah Q, He Jianping, McCarter Robert, Teach Stephen J
Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Pediatr Emerg Care. 2012 Oct;28(10):956-61. doi: 10.1097/PEC.0b013e31826c6dde.
We sought to determine diagnosis-specific rates of follow-up with primary care providers (PCPs) after emergency department (ED) visits for respiratory tract illnesses. We hypothesized that follow-up rates would be higher among patients with acute infectious illnesses than among those with asthma.
This was a retrospective cohort study of a random sample of patients aged 0 to 12 years discharged over a 12-month period from an urban, tertiary care pediatric ED with 4 different respiratory tract illnesses (asthma, bronchiolitis, croup, and pneumonia). Primary care provider follow-up was examined for associations with sociodemographic and clinical factors and with subsequent ED visits.
Rates of follow-up in the overall cohort were low: 23.6% (95% confidence interval, 19.7-27.4) by 7 days and 40.5% (95% confidence interval, 36.0-44.9) by 30 days. Compared with patients with asthma, the relative risks (RRs) of follow-up within 7 and 30 days were significantly higher among patients with bronchiolitis and pneumonia, but not with croup. For the cohort as a whole, the RR of follow-up within 7 and 30 days significantly decreased for each 1-year increase in age, and the RR of follow-up within 7 days significantly increased with the provision of explicit ED discharge instructions recommending follow-up. Among patients with asthma, follow-up with PCPs within 30 days was not associated with decreased ED visits for asthma over the following year.
Rates of PCP follow-up were globally low but significantly higher for patients with acute infectious illnesses, for younger patients, and for those receiving explicit ED discharge instructions.
我们试图确定因呼吸道疾病在急诊科就诊后，由初级保健提供者（PCP）进行随访的特定诊断率。我们假设急性感染性疾病患者的随访率高于哮喘患者。
这是一项回顾性队列研究，对12个月内从一家城市三级护理儿科急诊科出院的0至12岁随机抽样患者进行研究，这些患者患有4种不同的呼吸道疾病（哮喘、细支气管炎、喉炎和肺炎）。研究了初级保健提供者的随访情况与社会人口统计学和临床因素以及随后的急诊科就诊之间的关联。
整个队列的随访率较低：7天时为23.6%（95%置信区间，19.7 - 27.4），30天时为40.5%（95%置信区间，36.0 - 44.9）。与哮喘患者相比，细支气管炎和肺炎患者在7天和30天内随访的相对风险（RR）显著更高，但喉炎患者并非如此。对于整个队列，年龄每增加1岁，7天和30天内随访的RR显著降低，而提供明确的急诊科出院随访建议会使7天内随访的RR显著增加。在哮喘患者中，30天内由初级保健提供者进行随访与次年哮喘患者的急诊科就诊减少无关。
初级保健提供者的随访率总体较低，但急性感染性疾病患者、年轻患者以及接受明确急诊科出院随访建议的患者的随访率显著更高。
