PolicyLab,
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Pediatrics. 2020 Nov;146(5). doi: 10.1542/peds.2019-3108. Epub 2020 Oct 1.
A relatively small proportion of children with asthma account for an outsized proportion of health care use. Our goal was to use quality improvement methodology to reduce repeat emergency department (ED) and inpatient care for patients with frequent asthma-related hospitalization.
Children ages 2 to 17 with ≥3 asthma-related hospitalizations in the previous year who received primary care at 3 in-network clinics were eligible to receive a bundle of 4 services including (1) a high-risk asthma screener and tailored education, (2) referral to a clinic-based asthma community health worker program, (3) facilitated discharge medication filling, and (4) expedited follow-up with an allergy or pulmonology specialist. Statistical process control charts were used to estimate the impact of the intervention on monthly 30-day revisits to the ED or hospital. We then conducted a difference-in-differences analysis to compare changes between those receiving the intervention and a contemporaneous comparison group.
From May 1, 2016, to April 30, 2017, we enrolled 79 patients in the intervention, and 128 patients constituted the control group. Among the eligible population, the average monthly proportion of children experiencing a revisit to the ED and hospital within 30 days declined by 38%, from a historical baseline of 24% to 15%. Difference-in-differences analysis demonstrated 11.0 fewer 30-day revisits per 100 patients per month among intervention recipients relative to controls (95% confidence interval: -20.2 to -1.8; = .02).
A multidisciplinary quality improvement intervention reduced health care use in a high-risk asthma population, which was confirmed by using quasi-experimental methodology. In this study, we provide a framework to analyze broader interventions targeted to frequently hospitalized populations.
一小部分患有哮喘的儿童占用了大量的医疗保健资源。我们的目标是使用质量改进方法减少因哮喘反复发作而频繁住院的患者再次急诊就诊和住院治疗的次数。
在过去一年中，年龄在 2 至 17 岁之间，有≥3 次因哮喘住院治疗经历，在 3 家联网诊所接受初级保健的患者有资格接受 4 项服务包，包括（1）高风险哮喘筛查和量身定制的教育，（2）转介到基于诊所的哮喘社区卫生工作者计划，（3）促进出院药物配给，（4）通过过敏或肺病专家加快跟进。统计过程控制图用于估计干预对每月 30 天内急诊或住院的影响。然后，我们进行了差异分析，以比较接受干预的患者和同期对照组之间的变化。
从 2016 年 5 月 1 日至 2017 年 4 月 30 日，我们对 79 名患者进行了干预，128 名患者构成对照组。在符合条件的人群中，30 天内急诊或医院就诊的儿童比例每月平均下降 38%，从历史基线的 24%降至 15%。差异分析显示，与对照组相比，干预组每月每 100 名患者有 11.0 次 30 天内就诊次数减少（95%置信区间：-20.2 至-1.8； =.02）。
一项多学科质量改进干预措施减少了高危哮喘人群的医疗保健使用，这一点通过使用准实验方法得到了证实。在这项研究中，我们提供了一个分析针对频繁住院人群的更广泛干预措施的框架。
