Post Graduate School of Public Health, University of Milan, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Ital J Pediatr. 2018 Nov 20;44(1):139. doi: 10.1186/s13052-018-0576-8.
Juvenile idiopathic arthritis (JIA) is the most common pediatric chronic rheumatic disease, which requires constant follow-up over the years, due to relapses during its progression. To maintain a good quality of life, it is important to limit admissions as far as possible. With the development of a Diagnostic Therapeutic Assistance Pathway (DTAP), we aim to select patients with suitable clinical conditions to be moved from routine hospital management to day care or outpatient treatment, evaluating the number of patients to whom this would apply.
Monocentric study regarding admissions for JIA between 2014 and 2016 in a Pediatric Unit of a university hospital in Milan. Through an analysis of the medical records, relevant information was extracted and collected in a Microsoft™ Excel database; starting from the data collected during the first year, a DTAP was prepared for patients with active arthritis and appropriate clinical conditions.
The study includes data from 223 JIA hospitalization cases involving 127 patients. Applying DTAP criteria, 32% patients would have avoided admissions and 23% would have been admitted less frequently. The data concerning the activities of the Unit for JIA patients showed a relevant drop in the number of hospitalizations since 2015, from 89 in 2014 to 66 and 68 in 2015 and 2016 respectively.
The opportunity offered by DTAP, has suggested feasible changes in hospitalization management and it's use would promote the possibility of treating the children without hospitalization, or minimizing it. In conclusion DTAP application is a priority for the continuous improvement of clinical practice and quality of life for patients and their families.
幼年特发性关节炎（JIA）是最常见的儿科慢性风湿性疾病，由于其进展过程中会出现复发，因此需要多年持续随访。为了保持良好的生活质量，尽可能减少住院治疗非常重要。通过制定诊断治疗援助途径（DTAP），我们旨在选择具有合适临床条件的患者，将其从常规医院管理转移到日间护理或门诊治疗，并评估适用患者的数量。
这是一项针对米兰一家大学医院儿科病房 2014 年至 2016 年 JIA 住院病例的单中心研究。通过对病历进行分析，提取并收集相关信息，录入 Microsoft Excel 数据库；根据第一年收集的数据，为活动期关节炎且具有合适临床条件的患者制定了 DTAP。
本研究共纳入了 127 名患者的 223 例 JIA 住院病例。根据 DTAP 标准，32%的患者可避免住院，23%的患者住院频率降低。JIA 患者病房活动数据显示，自 2015 年以来，住院人数明显减少，从 2014 年的 89 例降至 2015 年的 66 例和 2016 年的 68 例。
DTAP 提供了一种可行的住院管理改变机会，它的使用将促进儿童无需住院或尽量减少住院治疗的可能性。总之，DTAP 的应用是持续改进临床实践和患者及其家属生活质量的优先事项。
