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不同种族/族裔群体在出院时哮喘护理方面的差异。

Variation in asthma care at hospital discharge by race/ethnicity groups.

作者信息

Trent Stacy A, Hasegawa Kohei, Ramratnam Sima K, Bittner Jane C, Camargo Carlos A

机构信息

a Department of Emergency Medicine , Denver Health Medical Center , Denver , CO , USA.

b University of Colorado School of Medicine , Aurora , CO , USA.

出版信息

J Asthma. 2018 Sep;55(9):939-948. doi: 10.1080/02770903.2017.1378356. Epub 2017 Nov 7.

Abstract

: While asthma disproportionately affects minorities, little is known about racial/ethnic differences in asthma care at hospital discharge. : Secondary data analysis of multicenter retrospective study using standardized medical record review. A random sample of patients aged 2-54 years, who were hospitalized for asthma at 25 hospitals from 2012 to 2013 was analyzed. We categorized patients into three race/ethnicity groups: non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic. Multivariable logistic regression using generalized estimating equations was used to examine the relationship between race/ethnicity and the provision of guideline-concordant asthma care at hospital discharge including: the provision of asthma action plans, provision of new prescription of an inhaled corticosteroid, and referral to an asthma specialist. : Nine hundred thirteen patients (39% children, 71% minorities) hospitalized for asthma were included. In adjusted models, NHB children were significantly less likely to receive a written asthma action plan (OR 0.48; 95% CI 0.31-0.76) than NHW children. In contrast, among adults, we found no statistically significant difference in the provision of asthma action plan. Additionally, we found no difference in the provision of a new inhaled corticosteroid prescription or referral to an asthma specialist among children or adults. : NHB and Hispanic patients represent the majority of patients hospitalized for acute asthma in our cohort and were more likely than NHW patients to have increased markers of asthma severity. Despite this, the only significant racial/ethnic difference in asthma care at hospital discharge was among NHB children, who were less likely to receive a written asthma action plan .

摘要

虽然哮喘对少数族裔的影响尤为严重,但对于出院时哮喘护理中的种族/民族差异却知之甚少。:使用标准化病历审查对多中心回顾性研究进行二次数据分析。分析了2012年至2013年在25家医院因哮喘住院的2至54岁患者的随机样本。我们将患者分为三个种族/民族组:非西班牙裔白人(NHW)、非西班牙裔黑人(NHB)和西班牙裔。使用广义估计方程的多变量逻辑回归用于检验种族/民族与出院时提供符合指南的哮喘护理之间的关系,包括:提供哮喘行动计划、提供吸入性糖皮质激素新处方以及转诊至哮喘专科医生。:纳入了913名因哮喘住院的患者(39%为儿童,71%为少数族裔)。在调整模型中,NHB儿童比NHW儿童获得书面哮喘行动计划的可能性显著降低(比值比0.48;95%置信区间0.31 - 0.76)。相比之下,在成年人中,我们发现提供哮喘行动计划方面没有统计学上的显著差异。此外,我们发现儿童或成年人在提供新的吸入性糖皮质激素处方或转诊至哮喘专科医生方面没有差异。:NHB和西班牙裔患者占我们队列中因急性哮喘住院患者的大多数,并且比NHW患者更有可能出现哮喘严重程度增加的指标。尽管如此,出院时哮喘护理中唯一显著的种族/民族差异在于NHB儿童,他们获得书面哮喘行动计划的可能性较小。

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