Rangachari Pavani, Mehta Renuka, Rethemeyer R Karl, Ferrang Carole, Dennis Clifton, Redd Vickie
Department of Health Management & Informatics, Georgia Regents University, Augusta, Georgia, United States.
Department of Pediatrics, Georgia Regents University, Augusta, Georgia, United States.
J Hosp Adm. 2015 Oct;4(5):26-39. doi: 10.5430/jha.v4n5p26. Epub 2015 Jun 16.
At the Children's Hospital of Georgia (CHOG), we found that outpatient revisits for pediatric asthma were significantly above national norms. According to the NIH, costly hospital revisits for asthma can be prevented through guidelines-based self-management of asthma, central to which, is the use of a written Asthma-Action Plan (AAP).
The asthma services literature has emphasized the role of the healthcare provider in promoting asthma self-management using the AAP, to prevent hospital revisits. On the other hand, the asthma policy literature has emphasized the need for community-based interventions to promote asthma self-management. A gap remains in understanding the extent of leverage that healthcare providers may have in preventing hospital revisits for asthma, through effective communication of AAP in the outpatient setting. Our study sought to address this gap.
We conducted a 6-month intervention to implement "patient-and-family-centered communication of the AAP" in CHOG outpatient clinics, based on the "change-management" theoretical framework. Provider communication of AAP was assessed through a survey of "Parent Understanding of the Child's AAP." A quasi-experimental approach was used to measure outpatient revisits for pediatric asthma, pre- and post-intervention.
Survey results showed that provider communication of the AAP was unanimously perceived highly positively by parents of pediatric asthma patients, across various metrics of patient-centered care. However, there were no statistically significant differences in outpatient "revisit behavior" for pediatric asthma between pre- and post-intervention periods after controlling for several demographic variables. Additionally, revisits remained significantly above national norms.
Results suggest limited potential of "effective provider communication of AAP," in reducing outpatient revisits for pediatric asthma; and indicate need for broader community-based interventions to address patient life variables impacting self-management and hospital revisits for pediatric asthma. Findings suggest need for a revised "socio-ecological" theoretical framework, and also provide insight into various policy, research, and practice implications for asthma management and control.
在佐治亚州儿童医院（CHOG），我们发现儿科哮喘门诊复诊率显著高于全国标准。根据美国国立卫生研究院（NIH）的研究，通过基于指南的哮喘自我管理可以预防哮喘患者昂贵的住院复诊，其中关键是使用书面的哮喘行动计划（AAP）。
哮喘服务文献强调了医疗服务提供者在使用AAP促进哮喘自我管理以预防住院复诊方面的作用。另一方面，哮喘政策文献强调了基于社区的干预措施对促进哮喘自我管理的必要性。在理解医疗服务提供者通过在门诊环境中有效传达AAP来预防哮喘住院复诊的影响力方面，仍存在差距。我们的研究旨在填补这一差距。
我们基于“变革管理”理论框架，在CHOG门诊进行了为期6个月的干预，以实施“以患者和家庭为中心的AAP沟通”。通过对“家长对孩子AAP的理解”的调查来评估医疗服务提供者对AAP的沟通情况。采用准实验方法测量干预前后儿科哮喘门诊复诊情况。
调查结果显示，在以患者为中心的护理的各种指标上，儿科哮喘患者的家长对医疗服务提供者对AAP的沟通一致给予高度积极评价。然而，在控制了几个人口统计学变量后，干预前后儿科哮喘门诊“复诊行为”没有统计学上的显著差异。此外，复诊率仍显著高于全国标准。
结果表明，“医疗服务提供者有效沟通AAP”在减少儿科哮喘门诊复诊方面的潜力有限；并表明需要更广泛的基于社区的干预措施来解决影响儿科哮喘自我管理和住院复诊的患者生活变量。研究结果表明需要一个修订的“社会生态”理论框架，同时也为哮喘管理和控制的各种政策、研究及实践启示提供了见解。
