全州哮喘学习协作参与与哮喘相关急诊就诊。

Statewide Asthma Learning Collaborative Participation and Asthma-Related Emergency Department Use.

机构信息

Departments of Pediatrics and

Psychiatry, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont.

出版信息

Pediatrics. 2020 Dec;146(6). doi: 10.1542/peds.2020-0213.

DOI:10.1542/peds.2020-0213

PMID:33229467

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10494521/

Abstract

BACKGROUND

Quality improvement (QI) efforts can improve guideline-recommended asthma care processes in the pediatric office setting. We sought to assess whether practice participation in an asthma QI collaborative was associated with decreased asthma-related emergency department (ED) visits.

METHODS

A statewide network of practices participated in a pediatric asthma QI collaborative from 2015 to 2016. We evaluated asthma-related ED visit rates per 100 child-years for children ages 3 to 21 years with asthma, using the state's all-payer claims database. We used a difference-in-differences approach, with mixed-effects negative binomial regression models to control for practice and patient covariates. Our main analysis measured the outcome before (2014) and after (2017) the QI collaborative at fully participating and control practices. Additional analyses assessed (1) associations during the intervention period (2016) and (2) associations including practices partially participating in QI collaborative activities.

RESULTS

In the postintervention year (2017), participating practices' ( = 20) asthma-related ED visit rate decreased by 5.8 per 100 child-years, compared to an increase of 1.8 per 100 child-years for control practices ( = 15; difference in differences = -7.3; = .002). Within the intervention year (2016), we found no statistically significant differences in asthma-related ED visit rates compared to controls (difference in differences = -4.3; = .17). The analysis including partially participating practices yielded similar results and inferences to our main analysis.

CONCLUSIONS

Participation in an asthma-focused QI collaborative was associated with decreased asthma-related ED visit rates. For those considering implementing this type of QI collaborative, our findings indicate that it takes time to see measurable improvements in ED visit rates. Further study is warranted regarding QI elements contributing to success for partial participants.

摘要

背景

质量改进（QI）工作可以改善儿科诊所中推荐的哮喘护理流程。我们试图评估实践参与哮喘 QI 合作是否与减少哮喘相关的急诊部（ED）就诊有关。

方法

一个全州范围内的实践网络参与了 2015 年至 2016 年的儿科哮喘 QI 合作。我们使用该州的所有支付者索赔数据库，评估了年龄在 3 至 21 岁的哮喘儿童每 100 名儿童年的哮喘相关 ED 就诊率。我们使用差异中的差异方法，使用混合效应负二项式回归模型来控制实践和患者协变量。我们的主要分析在 QI 合作的完全参与和控制实践之前（2014 年）和之后（2017 年）测量结果。额外的分析评估了（1）干预期间的关联（2016 年）和（2）包括部分参与 QI 合作活动的实践的关联。

结果

在干预年后（2017 年），参与实践的哮喘相关 ED 就诊率降低了 5.8/100 名儿童年，而对照组的就诊率增加了 1.8/100 名儿童年（差异= -7.3；=.002）。在干预年内（2016 年），与对照组相比，我们发现哮喘相关 ED 就诊率没有统计学上的显著差异（差异= -4.3；=.17）。包括部分参与实践的分析得出了与我们的主要分析相似的结果和推论。