Tapp Hazel, Shade Lindsay, Mahabaleshwarkar Rohan, Taylor Yhenneko J, Ludden Thomas, Dulin Michael F
a Department of Family Medicine , Carolinas HealthCare System , Charlotte , NC , USA.
b Center for Outcome Research and Evaluation, Carolinas HealthCare System , Charlotte , NC , USA.
J Asthma. 2017 May;54(4):392-402. doi: 10.1080/02770903.2016.1227333. Epub 2016 Nov 4.
Patient/provider shared decision making (SDM) improves asthma control in a pragmatic clinical trial setting. This study evaluated the impact of an evidence-based SDM toolkit on outcomes for patients with asthma implemented by providers in a real world setting. We hypothesized that these patients with asthma would demonstrate improved outcomes such as reduced emergency department (ED) visits, hospitalizations, and oral steroid use in the 12 months following a SDM visit compared to those who did not receive the intervention.
Patients with asthma were identified within six primary care practices that serve vulnerable populations in Charlotte, NC (746 children; 718 adult patients). Propensity scores were used to match 200 children and 206 adults for analysis. The primary outcome variable was asthma exacerbation defined as an ED visit or hospitalization for asthma or outpatient prescription of an oral steroid. Patients were monitored at 3, 6, and 12 months after the intervention date. The outcome variables of ED visits, hospitalizations, and oral steroids were compared between intervention and matched control patients.
The proportion of pediatric patients with one or more exacerbations was significantly lower in the SDM intervention group compared to controls during 12 months after exposure to the intervention (33% vs. 47%, p = 0.023). For adults, there was not a strong association between use of the SDM intervention and outcomes improvement.
The evidence-based SDM intervention implemented in this study was associated with improved asthma outcomes for pediatric patients but not adult patients in a real world clinical setting.
在一项务实的临床试验环境中，患者/医疗服务提供者共同决策（SDM）可改善哮喘控制情况。本研究评估了基于证据的SDM工具包对医疗服务提供者在现实环境中为哮喘患者实施的治疗结果的影响。我们假设，与未接受干预的患者相比，这些哮喘患者在进行SDM问诊后的12个月内会表现出更好的治疗结果，如急诊就诊次数、住院次数减少以及口服类固醇药物的使用减少。
在北卡罗来纳州夏洛特市为弱势群体提供服务的6家初级保健机构中确定哮喘患者（746名儿童；718名成年患者）。使用倾向得分匹配200名儿童和206名成年人进行分析。主要结局变量为哮喘加重，定义为因哮喘急诊就诊或住院或口服类固醇药物的门诊处方。在干预日期后的3个月、6个月和12个月对患者进行监测。比较干预组和匹配对照组患者的急诊就诊、住院和口服类固醇药物的结局变量。
在接触干预后的12个月内，SDM干预组中出现一次或多次加重的儿科患者比例显著低于对照组（33%对47%，p = 0.023）。对于成年人，使用SDM干预与结局改善之间没有很强的关联。
在本研究中实施的基于证据的SDM干预在现实临床环境中与儿科患者哮喘结局改善相关，但与成年患者无关。
