Andrews Annie Lintzenich, Simpson Annie N, Basco William T, Teufel Ronald J
Department of Pediatrics.
Department of Healthcare Leadership and Management.
Medicare Medicaid Res Rev. 2013 Dec 16;3(4). doi: 10.5600/mmrr.003.04.a05. eCollection 2013.
To determine if the asthma medication ratio predicts subsequent emergency department (ED) visits and hospital admissions in children.
Retrospective cohort with two year pairs.
SETTING/PARTICIPANTS: 2007-2009 South Carolina Medicaid recipients with persistent asthma age 2-18.
Controller-to-total asthma medication ratios were calculated for each patient in 2007 and 2008. Ratios range from 0-1 (1 = ideal, 0 = no controller).
2008 and 2009 asthma related ED visits, hospitalizations, and a combined outcome of ED visit or hospitalization in the subsequent 3, 6, and 12 month time periods.
19,512 patients were included. Mean age 8.9 years, 58% male, and 55% black. The ratio significantly predicted ED visits and hospitalizations over subsequent 3, 6, and 12 month time periods. The cut-point that maximized the ability to predict visits ranged from 0.4-0.6. A cutpoint of 0.5 was used in the final models. After controlling for age, race, gender, and rurality, patients with a ratio <0.5 were significantly more likely to have a subsequent emergent healthcare visit (OR 1.5-2.0). The ratio retained its predictive ability in both year-pairs for all three outcome variables, in all three time periods, with the exception of the 2008 ratio not predicting 2009 3-month and 6-month hospitalizations.
The asthma medication ratio is a significant predictor of ED visits and hospitalizations in children. Using a cutoff of <0.5 to signal at-risk patients may be an effective way for populations who would benefit from increased use of controller medications to reduce future emergent asthma visits. CPT only copyright XXXX-2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. See attached CMS CPT 2013 end user license.
确定哮喘药物使用比例是否能预测儿童随后的急诊科就诊和住院情况。
为期两年的回顾性队列研究。
地点/参与者：2007 - 2009年南卡罗来纳州医疗补助计划中年龄在2至18岁的持续性哮喘患者。
计算了2007年和2008年每位患者的控制药物与总哮喘药物使用比例。比例范围为0至1（1表示理想状态，0表示未使用控制药物）。
2008年和2009年与哮喘相关的急诊科就诊、住院情况，以及在随后3个月、6个月和12个月时间段内急诊科就诊或住院的综合结果。
纳入19512名患者。平均年龄8.9岁，58%为男性，55%为黑人。该比例显著预测了随后3个月、6个月和12个月时间段内的急诊科就诊和住院情况。预测就诊能力最强的切点范围为0.4至0.6。最终模型中使用的切点为0.5。在控制了年龄、种族、性别和农村地区因素后，比例<0.5的患者随后进行紧急医疗就诊的可能性显著更高（比值比1.5 - 2.0）。对于所有三个观察变量，在所有三个时间段内，该比例在两个年度对中均保持其预测能力，但2008年的比例未能预测2009年3个月和6个月的住院情况。
哮喘药物使用比例是儿童急诊科就诊和住院情况的重要预测指标。对于那些可能从增加使用控制药物中获益的人群，使用<0.5的切点来识别高危患者可能是减少未来哮喘紧急就诊的有效方法。版权所有XXXX - 2012美国医学协会。保留所有权利。CPT是美国医学协会的注册商标。适用联邦采购法规/国防联邦采购法规适用于政府使用。费用表、相对价值单位、转换因子和/或相关组件不由美国医学协会指定，不属于CPT的一部分，美国医学协会也不推荐使用。美国医学协会不直接或间接行医或提供医疗服务。美国医学协会对本文所含或未含数据不承担任何责任。请参阅随附的CMS CPT 2013最终用户许可协议。
