Vollmer W M, Osborne M L, Buist A S
Kaiser Permanente, Center for Health Research, Portland, OR 97227-1098.
Am Rev Respir Dis. 1993 Feb;147(2):347-53. doi: 10.1164/ajrccm/147.2.347.
Studies reporting increased asthma hospitalizations and mortality in the United States and abroad have heightened concern about the changing epidemiology of asthma. We studied 20-yr patterns of acute asthma care occurring at two large community hospitals among members of a large health maintenance organization. The presentation focuses on the conceptualization and operationalization of an "episode" of asthma care, defined as a collection of encounters (emergency room visits, urgency care visits, and hospital admissions) that cluster in time, as well as on changes in episode rates over time. We found a statistically significant increase in asthma episodes among boys younger than 5 yr of age that continued unabated from 1967 to 1987 despite a drop in asthma hospitalization rates starting in 1985. We hypothesize that this difference may reflect a change in emergency room management practices and not a true change in the underlying epidemiology of asthma. The concept of an episode of acute asthma care has not been studied in the literature and represents a potentially useful methodologic innovation. Particularly in the context of managed health care systems, studies of such episodes may be less sensitive than studies of hospital admissions to changes in the organization and delivery of acute asthma care, and thus may be better suited for studying changes in the epidemiology of asthma.
在美国和其他国家，有研究报告称哮喘住院率和死亡率有所上升，这引发了人们对哮喘流行病学变化的高度关注。我们研究了一家大型健康维护组织成员在两家大型社区医院接受急性哮喘治疗的20年模式。本报告重点关注哮喘治疗“发作期”的概念化和操作化，将其定义为在时间上聚集的一系列就诊（急诊室就诊、紧急护理就诊和住院），以及发作期发生率随时间的变化。我们发现，5岁以下男孩的哮喘发作期有统计学意义的增加，从1967年到1987年持续上升，尽管从1985年起哮喘住院率有所下降。我们推测，这种差异可能反映了急诊室管理实践的变化，而不是哮喘潜在流行病学的真正变化。急性哮喘治疗发作期的概念在文献中尚未得到研究，它代表了一种潜在有用的方法创新。特别是在管理式医疗保健系统的背景下，对这类发作期的研究可能比住院研究对急性哮喘治疗的组织和提供方式的变化不太敏感，因此可能更适合研究哮喘流行病学的变化。
