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首页> 外文期刊>Journal of asthma & allergy educators. >A Clinical Improvement Project: Reducing Default Rates at a Fast Track Asthma Clinic
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A Clinical Improvement Project: Reducing Default Rates at a Fast Track Asthma Clinic

机译：临床改进项目：减少快速轨道哮喘诊所的违约率

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Introduction. Patients seen at the emergency department (ED) with poor asthma control at a tertiary hospital in Singapore were fast-tracked to the asthma clinic to stabilize and optimize asthma control. However, the default rates at the fast track clinic (FTC) were high since its initiation, hence the need to initiate a quality improvement project to tackle the default rate as well as to reduce patients' health care utilization and cost. Aim. The aims were to reduce the default rate of referred appointments from the ED to the FTC from the current 50% to less than 10%, to assess the demographic factors associated with patients canceling and defaulting appointments, and to assess short-term health care utilization and costs for patients who were referred to the FTC. Method. Quality improvement project using the clinical practice improvement methodology. Results. The default rates at the FTC were reduced from 50% to less than 10%. There were significant reductions in health care utilization in the 3-month post-FTC scheduled visits (P <.001) in terms of revisits to the ED, readmissions, and cost. Age and ethnicity were found to be significantly associated with cancellations and defaults in the univariate model. The ethnic Malays were 2.4 times (95% confidence interval [CI] = 1.1-5.2) more likely to default when compared with ethnic Chinese (P =.032). In terms of age, the relative risk ratio of default decreased by a factor of 0.96 (95% CI = 0.93-0.99) for every year increase in age (P = .003). Conclusion. The clinical practice improvement project aided in reducing default rates to less than 10%. There were reductions in the number of ED revisits, rehospitalization, and cost for patients who showed up at the FTC as well as for those who defaulted and cancelled appointments. However, it did not indicate that those who showed up at the FTCs were doing better than those who cancelled or defaulted in terms of cost and reduction in health care utilization.
机译：介绍。在新加坡的第三节医院的哮喘患者中看到的急诊肿瘤（ED）的患者被快速跟踪到哮喘诊所，以稳定和优化哮喘控制。但是，快速轨道诊所（FTC）的违约率很高，自于其启动以来，需要启动质量改进项目来解决违约率，并降低患者的医疗保健利用率和成本。目的。目标是将从目前的50％的FTC从ed转到的违约率降低到少于10％，以评估与患者取消和违约约会相关的人口因子，并评估短期保健利用并提交FTC的患者的费用。方法。利用临床实践改进方法的质量改进项目。结果。 FTC的违约率从50％降至低于10％。在向ED，Readmissions和成本的重新访问方面，在3个月的FTC预定访问（P <.001）中，在3个月后的医疗保健利用率下降。发现年龄和种族与单变量模型中的取消和违约有关。与族裔汉语相比，族裔马来西亚马来患有2.4次（95％的置信区间[CI] = 1.1-5.2）。在年龄方面，违约的相对风险比率下降0.96（95％CI = 0.93-0.99），每年增加（P = .003）。结论。临床实践改进项目促进将违约率降至不到10％。在FTC出现的患者的ED Revisits，Rehospiration和成本的数量减少以及违约和取消约会的患者。但是，它并没有表明，那些在FTCS上出现的人比在成本和卫生利用率降低的那些取消或违约的人做得更好。

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