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Improved Asthma Outcomes Using a Coordinated Care Approach in a Large Medical Group

机译：大型医疗机构采用协调护理方法改善哮喘的结果

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The objective of this study was to review the development of a multidisciplinary asthma disease management program in a large medical group practice in an urban area, and evaluate the impact of the program on processes of care and health care utilization for adults and children with asthma. The disease management intervention included the development of a patient registry, a systematic approach to assessment of asthma control using the Asthma Therapy Assessment Questionnaire (ATAQ), case management, and physician education. An administrative database was used to examine hospital admissions and emergency department (ED) visits. A medical record audit was conducted to examine recorded compliance with asthma guidelines and documentation practices. The baseline study population included 3,486 adults and children with asthma. The ATAQ suggested that, at baseline, control problems were frequent, with 34% of adult respondents missing work because of asthma. ATAQ also revealed several areas for care improvement. For example, only 20% of adult respondents reported having a written treatment plan. The chart review and administrative claims analyses showed that the program had beneficial results in several areas. Medical record documentation improved for asthma diagnosis (83.3% vs. 98.6%; p < 0.001) and patient education (15.7% vs. 26.1%; p < 0.001). No improvements were seen in documentation of peak flow ownership/use, smoking cessation advice, or influenza vaccination. ED visits related to asthma decreased from 148 per 1000 to 88 per 1000 (p < 0.001), and hospitalizations related to asthma decreased from 81 per 1000 to 37 per 1000 (p < 0.001). The outcomes suggest that this program was associated with a marked reduction in rates of hospitalization and ED usage for asthma, as well as significant improvement in several essential processes of care.
机译：这项研究的目的是回顾城市地区大型医疗团队实践中多学科哮喘疾病管理计划的发展，并评估该计划对成人和儿童哮喘的护理和医疗保健利用过程的影响。疾病管理干预措施包括患者注册系统的开发，使用哮喘治疗评估问卷（ATAQ）评估哮喘控制的系统方法，病例管理和医师教育。一个行政数据库被用来检查医院的入院和急诊室（ED）的访问。进行了病历审核，以检查记录的对哮喘指南和文件操作的依从性。基线研究人群包括3,486名成人和儿童哮喘。 ATAQ建议，在基线时，控制问题经常发生，有34％的成年受访者因哮喘而失业。 ATAQ还透露了需要改进的几个方面。例如，只有20％的成年受访者报告有书面治疗计划。图表审查和行政索赔分析表明，该计划在多个领域都取得了有益的成果。病历记录改善了哮喘的诊断率（分别为83.3％和98.6％； p <0.001）和患者教育（分别为15.7％和26.1％； p <0.001）。在高峰流量拥有/使用，戒烟建议或流感疫苗接种的文档中，没有发现任何改善。与哮喘有关的急诊就诊从每千人148例减少到每1000例88人（p <0.001），与哮喘有关的住院治疗从每1000例81例减少到每1000例37例（p <0.001）。结果表明，该计划与住院率和哮喘急诊使用率的显着降低以及几个基本护理过程的显着改善有关。

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