Bush P J, Rabin D L
Pediatr Res. 1980 Oct;14(10):1115-7. doi: 10.1203/00006450-198010000-00005.
In 1975-1976, an experiment was performed at three sites of an HMO to investigate the effect of a protocol on drug prescribing for otitis media. A large and unexpected difference in encounter rates for otitis media was found among the sites. In the first 6 months of 1975, the rate of children less than 15 years with at least one encounter for otitis media at site EI was 155 per 1000 children, compared to 15 per 1000 at site EII. During the study period, most of the patients at site EII were black. The purpose of this paper is to alert readers to factors that affect the rates of disease in clinical practice, to encourage others to suggest reasons for the difference, and to encourage research. Several explanations were investigated to explain the differences: (1) miscoding; (2) age differences; (3) payment status; (4) diagnostic style; (5) differences in encounters per episode; and (6) social differences. Encounters of purulent otitis media were probably not systematically miscoded. The age distribution within the sites was almost identical. The difference in the encounter rates was even greater for children less than 15 years when only the enrolled population was examined. National incidence rates of otitis media showed rates for all ages for whites were 4.1% and for blacks 2.5%. The average number of encounters per episode was 1.4 at all of the study sites. Enrolled children at site EI had higher encounter rates for all reasons than children at site EII. Differences in diagnostic style may account for part of the difference in otitis media between the sites. Differences in encounter rates may also be due to real differences in disease occurrence between blacks and whites, differences in the perception of ear infection, and differences in the tendency to visit a physician for ear problems.
1975年至1976年期间，在一家健康维护组织（HMO）的三个地点进行了一项实验，以研究一种方案对中耳炎药物处方的影响。研究发现，各地点中耳炎的就诊率存在巨大且出乎意料的差异。1975年的前6个月，EI地点每1000名15岁以下儿童中至少有一次中耳炎就诊记录的比例为155例，而EII地点为每1000名中有15例。在研究期间，EII地点的大多数患者为黑人。本文旨在提醒读者注意临床实践中影响疾病发生率的因素，鼓励其他人提出差异存在的原因，并鼓励开展研究。为解释这些差异，研究了几种可能的原因：（1）编码错误；（2）年龄差异；（3）支付状态；（4）诊断方式；（5）每次发作的就诊次数差异；（6）社会差异。化脓性中耳炎的就诊记录可能没有系统性的编码错误。各地点的年龄分布几乎相同。仅考察登记在册的人群时，15岁以下儿童的就诊率差异更大。全国中耳炎发病率显示，所有年龄段白人的发病率为4.1%，黑人为2.5%。所有研究地点每次发作的平均就诊次数均为1.4次。EI地点登记在册的儿童因各种原因的就诊率均高于EII地点的儿童。诊断方式的差异可能是各地点中耳炎差异的部分原因。就诊率的差异也可能是由于黑人和白人之间疾病发生率的实际差异、耳部感染认知的差异以及因耳部问题就医倾向的差异。
