为严重功能性便秘患者制定的结构化肠道管理计划有助于减少急诊就诊次数、住院人数和医疗费用。
A structured bowel management program for patients with severe functional constipation can help decrease emergency department visits, hospital admissions, and healthcare costs.
作者信息
Reck-Burneo Carlos A, Vilanova-Sanchez Alejandra, Gasior Alessandra C, Dingemans Alexander J M, Lane Victoria A, Dyckes Robert, Nash Onnalisa, Weaver Laura, Maloof Tassiana, Wood Richard J, Zobell Sarah, Rollins Michael D, Levitt Marc A
机构信息
Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
出版信息
J Pediatr Surg. 2018 Sep;53(9):1737-1741. doi: 10.1016/j.jpedsurg.2018.03.020. Epub 2018 Mar 24.
BACKGROUND
Published health-care costs related to constipation in children in the USA are estimated at $3.9 billion/year. We sought to assess the effect of a bowel management program (BMP) on health-care utilization and costs.
METHODS
At two collaborating centers, BMP involves an outpatient week during which a treatment plan is implemented and objective assessment of stool burden is performed with daily radiography. We reviewed all patients with severe functional constipation who participated in the program from March 2011 to June 2015 in center 1 and from April 2014 to April 2016 in center 2. ED visits, hospital admissions, and constipation-related morbidities (abdominal pain, fecal impaction, urinary retention, urinary tract infections) 12 months before and 12 months after completion of the BMP were recorded.
RESULTS
One hundred eighty-four patients were included (center 1 = 96, center 2 = 88). Sixty-three (34.2%) patients had at least one unplanned visit to the ED before treatment. ED visits decreased to 23 (12.5%) or by 64% (p < 0.0005). Unplanned hospital admissions decreased from 65 to 28, i.e., a 56.9% reduction (p < 0.0005).
CONCLUSION
In children with severe functional constipation, a structured BMP decreases unplanned visits to the ED, hospital admissions, and costs for constipation-related health care.
LEVEL OF EVIDENCE
背景
据估计，美国儿童便秘相关的医疗保健费用每年达39亿美元。我们试图评估肠道管理计划（BMP）对医疗保健利用和费用的影响。
方法
在两个合作中心，BMP包括一个门诊周，在此期间实施治疗计划，并通过每日放射成像对粪便负担进行客观评估。我们回顾了2011年3月至2015年6月在中心1以及2014年4月至2016年4月在中心2参与该计划的所有重度功能性便秘患者。记录了BMP完成前12个月和完成后12个月的急诊就诊、住院情况以及便秘相关的发病情况（腹痛、粪便嵌塞、尿潴留、尿路感染）。
结果
共纳入184例患者（中心1 = 96例，中心2 = 88例）。63例（34.2%）患者在治疗前至少有一次计划外的急诊就诊。急诊就诊次数降至23次（12.5%），即减少了64%（p < 0.0005）。计划外住院次数从65次降至28次，即减少了56.9%（p < 0.0005）。
结论
对于重度功能性便秘儿童，结构化的BMP可减少计划外的急诊就诊、住院次数以及便秘相关医疗保健的费用。
证据级别
3级。
Zotero 插件