Vitacca Michele, Comini Laura, Barbisoni Marilena, Francolini Gloria, Paneroni Mara, Ramponi Jean Pierre
Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Lumezzane, Brescia, Italy.
Health Directorate, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Lumezzane, Brescia, Italy.
Rehabil Res Pract. 2017;2017:5710676. doi: 10.1155/2017/5710676. Epub 2017 Jan 23.
This retrospective study aimed to evaluate, through an ad hoc 17-item tool, the Pulmonary Rehabilitation Decisional Score (PRDS), the priority access to PR prescription by respiratory specialists. The PRDS, scoring functional, clinical, disability, frailty, and participation parameters from 0 = low priority to 34 = very high priority for PR access, was retrospectively calculated on 124 specialist reports sent to the GP of subjects (aged 71 ± 11 years, FEV% 51 ± 17) consecutively admitted to our respiratory outpatient clinic. From the specialist's report the final subject's allocation could be low priority (LP) (>60 days), high priority (HP) (30-60 days), or very high priority (VHP) (<30 days) to rehabilitation. The PRDS calculation showed scores significantly higher in VHP versus LP ( < 0.001) and significantly different between HP and VHP ( < 0.001). Comparing the specialist's allocation decision and priority choice based on PRDS cut-offs, PR prescription was significantly more appropriate in VHP than in HP ( = 0.016). Specialists underprescribed PR in 49% of LP cases and overprescribed it in 46% and 30% of the HP and VHP prescriptions, respectively. A multicomprehensive score is feasible being useful for staging the clinical priorities for PR prescription and facilitating sustainability of the health system.
这项回顾性研究旨在通过一个专门设计的包含17个条目的工具——肺康复决策评分（PRDS），评估呼吸专科医生开具肺康复（PR）处方的优先次序。PRDS对功能、临床、残疾、虚弱和参与参数进行评分，范围从0分（低优先级）到34分（PR准入的非常高优先级）。我们对连续收治到呼吸门诊的124份专科报告（患者年龄为71±11岁，第一秒用力呼气容积百分比[FEV%]为51±17）进行回顾性计算PRDS。根据专科报告，最终患者的康复分配可能为低优先级（LP）（>60天）、高优先级（HP）（30 - 60天）或非常高优先级（VHP）（<30天）。PRDS计算结果显示，VHP组的得分显著高于LP组（<0.001），HP组和VHP组之间也存在显著差异（<0.001）。根据PRDS临界值比较专科医生的分配决策和优先级选择，VHP组的PR处方比HP组显著更合适（=0.016）。在LP病例中，专科医生有49%的情况开具PR不足，而在HP和VHP处方中，分别有46%和30%的情况开具PR过度。一个多维度综合评分是可行的，有助于确定PR处方的临床优先级并促进卫生系统的可持续性。
