Rydman R J, Isola M L, Roberts R R, Zalenski R J, McDermott M F, Murphy D G, McCarren M M, Kampe L M
Department of Emergency Medicine, Cook County Hospital, Chicago, IL 60612, USA.
Med Care. 1998 Apr;36(4):599-609. doi: 10.1097/00005650-199804000-00015.
This study was designed to determine if an accelerated treatment protocol administered to acute asthmatics presenting to a Hospital Emergency Department Observation Unit (EDOU) can offset the need for inpatient admissions and reduce total cost per episode of care without sacrificing patient quality of life.
The authors used a prospective randomized controlled trial comparing postintervention patient quality of life for EDOU care versus standard inpatient care as measured by the standardized Medical Outcomes Study (MOS) SF-36 instrument. Other measures reported include: clinical status as measured by peak flow rates, total cost per treatment arm using microcosting techniques, and relapse-free survival 8 weeks after treatment. Eligible patients (n = 113) were assigned randomly to an EDOU or inpatient care from a consecutive sample of 250 acute asthmatic patients presenting to an urban hospital emergency department who could not resolve their acute asthma exacerbation after 3 hours of emergency department therapy.
Patients assigned to the EDOU had lower mean costs of treatment (EDOU = $1,202 versus Hospital Inpatient = $2,247) and higher quality of life outcomes after intervention in five of eight domains measured by the MOS SF-36: Physical Functioning, Role Functioning-Emotional, Social Functioning, Mental Health, and Vitality. No differences were found in clinical outcomes as measured by peak flow rates or postintervention relapse-free survival. Univariate comparative findings were re-examined and confirmed through multivariable analysis when baseline SF-36 scores and postintervention peak expiratory flow rates clinical status were used as covariates.
The study showed that the EDOU was a lower cost and more effective treatment alternative for a refractory asthmatic population presenting to the Emergency Department. Several baseline MOS SF-36 domains proved useful in predicting or validating posttreatment clinical status, relapse, and total costs of care. Outcome SF-36 domain scores were also useful in identifying patients with the most favorable clinical, cost, and relapse rate outcomes at the study endpoint.
本研究旨在确定，对于前往医院急诊科观察病房（EDOU）的急性哮喘患者，实施加速治疗方案是否能够避免患者住院，并在不影响患者生活质量的前提下降低每次治疗的总成本。
作者采用前瞻性随机对照试验，通过标准化的医学结局研究（MOS）SF-36量表，比较了EDOU护理与标准住院护理干预后患者的生活质量。报告的其他指标包括：通过峰值流速测量的临床状况、使用微观成本核算技术计算的每个治疗组的总成本，以及治疗后8周的无复发存活情况。符合条件的患者（n = 113）从250名前往城市医院急诊科的急性哮喘患者连续样本中随机分配至EDOU或住院治疗组，这些患者在急诊科治疗3小时后仍无法缓解急性哮喘发作。
分配至EDOU的患者平均治疗成本较低（EDOU = 1202美元，而医院住院治疗 = 2247美元），并且在MOS SF-36量表测量的八个领域中的五个领域干预后生活质量更高：身体功能、角色功能 - 情感、社会功能、心理健康和活力。通过峰值流速测量的临床结局或干预后无复发存活情况方面未发现差异。当将基线SF-36评分和干预后呼气峰值流速临床状况用作协变量时，通过多变量分析重新审视并确认了单变量比较结果。
该研究表明，对于前往急诊科的难治性哮喘患者群体，EDOU是一种成本更低且更有效的治疗选择。几个基线MOS SF-36领域被证明有助于预测或验证治疗后的临床状况、复发情况和护理总成本。结局SF-36领域评分也有助于在研究终点识别出临床、成本和复发率结局最有利的患者。
