Andrews Annie Lintzenich, Bundy David G, Simpson Kit N, Teufel Ronald J, Harvey Jillian, Simpson Annie N
Department of Pediatrics, Medical University of South Carolina College of Medicine, Medical University of South Carolina College of Medicine, Charleston, SC.
Department of Pediatrics, Medical University of South Carolina College of Medicine, Medical University of South Carolina College of Medicine, Charleston, SC.
Acad Pediatr. 2017 Mar;17(2):212-217. doi: 10.1016/j.acap.2016.10.016.
To determine rates of inhaled corticosteroid (ICS) claims and outpatient follow-up after asthma hospitalization among commercially insured children.
We conducted a retrospective cohort analysis of children hospitalized for asthma using 2013 national Truven MarketScan data. Covariates included age, sex, region, length of stay, and having an ICS claim within 35 days before hospitalization. Outcome variables were a claim for any ICS-containing medication and outpatient visit within 30 days after discharge. Multivariable analysis used logistic regression.
A total of 5471 children aged 2 to 17 were included; 61% were boys, and mean age was 6.8 years. Forty-one percent had a claim for an ICS and 76% had an outpatient visit within 30 days after hospital discharge. In multivariable analysis, children who had an ICS claim within 35 days before the hospitalization were more likely to have an ICS claim within 30 days after discharge (relative risk [RR] 1.3, 95% confidence interval [CI] 1.2-1.5). The strongest predictor of an ICS claim within 30 days after discharge was attendance at an outpatient appointment (RR 1.4, 95% CI 1.3-1.6). Children aged 2 to 6 were more likely to attend an outpatient appointment (RR 1.1, 95% CI 1.1-1.2). Children with an ICS claim before admission were also more likely to attend an outpatient appointment (RR 1.1, 95% CI 1.004-1.1).
In this national sample of commercially insured children with asthma, rates of ICS claims after hospitalization are low despite high rates of outpatient visits. Both inpatient and outpatient physicians must play a role in increasing ICS adherence in this high-risk population of children with asthma.
确定商业保险儿童哮喘住院后吸入性糖皮质激素（ICS）的索赔率及门诊随访情况。
我们利用2013年全国Truven MarketScan数据对因哮喘住院的儿童进行了一项回顾性队列分析。协变量包括年龄、性别、地区、住院时间以及住院前35天内是否有ICS索赔。结局变量为出院后30天内任何含ICS药物的索赔及门诊就诊情况。多变量分析采用逻辑回归。
共纳入5471名2至17岁儿童；61%为男孩，平均年龄为6.8岁。41%的儿童有ICS索赔，76%的儿童在出院后30天内进行了门诊就诊。在多变量分析中，住院前35天内有ICS索赔的儿童在出院后30天内更有可能有ICS索赔（相对风险[RR]为1.3，95%置信区间[CI]为1.2 - 1.5）。出院后30天内ICS索赔的最强预测因素是门诊预约就诊（RR为1.4，95% CI为1.3 - 1.6）。2至6岁儿童更有可能进行门诊预约就诊（RR为1.1，95% CI为1.1 - 1.2）。入院前有ICS索赔的儿童也更有可能进行门诊预约就诊（RR为1.1，95% CI为1.004 - 1.1）。
在这个全国性的商业保险哮喘儿童样本中，尽管门诊就诊率高，但住院后ICS索赔率较低。住院医师和门诊医师都必须在提高这一哮喘高危儿童群体对ICS的依从性方面发挥作用。
