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初级保健的连续性和哮喘年轻人群中的可避免住院治疗:基于人群的队列研究。

Continuity of primary care and avoidable hospitalization in a young population with asthma: a population-based cohort study.

机构信息

College of Pharmacy, Yeungnam University, 280 Daehak-ro, Gyeongsan, Gyeongbuk, 38541, Republic of Korea.

Department of Health Sciences, University of York, York, UK.

出版信息

Sci Rep. 2024 Nov 18;14(1):28395. doi: 10.1038/s41598-024-78057-3.

Abstract

Existing evidence regarding the impact of continuity of care (COC) in asthma patients is limited, and its quality is low to moderate. This study aimed to investigate associations between relational COC within primary care and asthma-related hospitalizations in children using a robust methodology. This study is a population-based cohort study that utilized a national claims database in South Korea. The study comprised 136,296 individuals under 20 years old who were newly diagnosed with asthma between 2015 and 2016. These were classified into high, medium, and low continuity groups based on the continuity of care index (COCI). The primary outcome measure was the incidence of asthma-related hospitalizations. During a two-year follow-up period, 10,922 patients (8.01%) were hospitalized: 2520 (5.59%) in the high-continuity group, 3188 (6.98%) in the medium-continuity group, and 3867 (8.48%) in the low-continuity group. After adjusting for confounding covariates, patients in the low- and medium-continuity groups exhibited significantly higher risks of hospital admission (adjusted hazard ratio (aHR) = 1.30 [95% confidence interval = 1.24-1.37] and aHR = 1.14 [1.08-1.20], than those in the high-continuity group. Sensitivity and subgroup analyses findings were consistent. In a young population with asthma increased continuity of primary care was associated with less hospitalization.

摘要

现有关于连续性护理(COC)对哮喘患者影响的证据有限,且其质量为低-中度。本研究旨在使用稳健的方法调查初级保健中关系性 COC 与儿童哮喘相关住院之间的关联。本研究是一项基于人群的队列研究,利用了韩国的一个国家索赔数据库。该研究纳入了 136296 名 20 岁以下的新诊断哮喘患者,他们在 2015 年至 2016 年期间被确诊为哮喘。根据连续性护理指数(COCI),这些患者被分为高、中、低连续性组。主要结局指标是哮喘相关住院的发生率。在两年的随访期间,有 10922 名患者(8.01%)住院:高连续性组 2520 名(5.59%),中连续性组 3188 名(6.98%),低连续性组 3867 名(8.48%)。调整混杂协变量后,低连续性和中连续性组的患者住院风险显著增加(调整后的危害比(aHR)=1.30[95%置信区间(CI)=1.24-1.37]和 aHR=1.14[1.08-1.20],高于高连续性组。敏感性和亚组分析结果一致。在哮喘的年轻人群中,增加初级保健的连续性与减少住院相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/88d1/11570610/7775d34cd4e2/41598_2024_78057_Fig1_HTML.jpg

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