Baylor College of Medicine, Houston, TX, USA.
J Natl Med Assoc. 2013 Summer;105(2):157-65. doi: 10.1016/s0027-9684(15)30109-7.
Sickle cell disease (SCD) is marked by high utilization of medical services. The aim of this study was to determine whether having a patient-centered medical home (PCMH) is associated with a reduction in emergency care (ED) utilization or hospitalizations among children with SCD.
We collected and analyzed data from parents of 150 children, ages 1 to 17 years, who received care within a large children's hospital. The primary dependent variables were rates of parent-reported ED visits and hospitalizations. The principal independent variable was parent-reported experience with an overall PCMH or its four individual components (regular provider, comprehensive care, family-centered care, and coordinated care). Multivariate negative binomial regression, yielding incident rate ratios (IRR), was used for analysis.
Children who received comprehensive care had half the rate of ED visits (IRR 0.51, 95% confidence interval, 0.33-0.78) and nearly half the rate of hospitalizations (IRR 0.56, 95% confidence interval, 0.33-0.93) compared to children without comprehensive care. No other component of the PCMH was significantly associated with ED visits or hospitalizations. Children reported to have excellent/very good/good health status had lower odds of ED visits and hospitalizations compared to those reported to be in fair/poor condition.
Children with SCD reported to experience comprehensive care had lower rates of ED encounters and hospitalizations after controlling for demographics and health status. The overall findings highlight that the provision of comprehensive care--having a usual source of care and no problems with referrals--may provide a strategy for improving pediatric SCD care.
镰状细胞病（SCD）的特点是医疗服务利用率高。本研究旨在确定患者为中心的医疗之家（PCMH）是否与 SCD 患儿急诊就诊率或住院率降低有关。
我们收集并分析了来自 150 名 1 至 17 岁接受大型儿童医院治疗的儿童父母的数据。主要因变量为父母报告的急诊就诊率和住院率。主要的独立变量是父母报告的对整体 PCMH 或其四个单独组成部分（常规提供者、全面护理、以家庭为中心的护理和协调护理）的体验。使用多元负二项回归，得出发病率比（IRR）进行分析。
与未接受全面护理的儿童相比，接受全面护理的儿童急诊就诊率降低了一半（IRR0.51，95%置信区间，0.33-0.78），住院率降低了近一半（IRR0.56，95%置信区间，0.33-0.93）。PCMH 的其他组成部分与急诊就诊或住院均无显著相关性。报告健康状况极好/非常好/良好的儿童急诊就诊和住院的可能性低于报告健康状况一般/较差的儿童。
在控制人口统计学和健康状况后，报告接受全面护理的 SCD 儿童急诊就诊率和住院率较低。总体结果强调了提供全面护理（有常规医疗来源，无转诊问题）可能是改善儿科 SCD 护理的一种策略。
