医疗救助人群中的流程质量检测与哮喘恶化的关系
2009/11/17
背景：哮喘质量评价常集中在哮喘控制性药物的使用，然而，上述治疗流程与临床效果之间的相关性在以症状报告为基础的研究中得出了不一致的结论。
目的：比较3个基于哮喘质量控制措施和哮喘恶化之间的相关性，以期深入了解哮喘治疗流程与临床效果的相关性。
方法：于2001～2002年在美国加利福尼亚州和纽约，采用采用针对哮喘的医疗保健有效性数据和信息集（HEDIS）标准入选从医疗救助中获益的持续性哮喘患者，纳入该队列研究。我们于2002年评估了的3个哮喘质量指标：（1）至少应用一种控制性药物的当前HEDIS检测；（2）至少4种控制性药物给药；（3）哮喘控制药物和总哮喘治疗药物比率至少0.5。在2003年，校正种族、性别、年龄、门诊患者及急性哮喘处理后，计算哮喘恶化优势比，作为每种质量检测方法的有效性。
结果：在加利福尼亚州（48.1%）和纽约（51.9%）共计90,909名持续性哮喘患者中，采用至少1种或至少4种哮喘控制药物治疗的患者预后较差的可能性增加（校正OR分别为1.80 [95% CI, 1.73-1.87]和1.44 [95% CI 1.40-1.48]）。满足哮喘控制药物与总哮喘治疗药物比率的检测患者，哮喘恶化的可能性减少23％（校正OR为0.77 [95% CI, 0.75-0.80]）。
结论：给予较高比例的哮喘控制药物显示哮喘恶化的可能性较低，但哮喘控制药物数量的增加与哮喘恶化增加相关。
（陈欣 审校）
J Allergy Clin Immunol. 2009 Sep 11.
Process quality measures and asthma exacerbations in the Medicaid population.
Yong PL, Werner RM.
BACKGROUND: Asthma quality assessment often focuses on controller medication use, yet claims-based studies find conflicting associations between this care process and clinical outcomes.
OBJECTIVE: We sought to compare the association between 3 controller-based quality measures and asthma exacerbations to gain better understanding of how processes of care are related to clinical outcomes.
METHODS: Identifying a cohort of Medicaid beneficiaries with persistent asthma by using Healthcare Effectiveness Data and Information Set (HEDIS) criteria for asthma in 2001-2002 in California and New York, we assessed 3 asthma quality metrics in 2002: (1) the current HEDIS measure of at least 1 controller medication filling; (2) at least 4 controller medication prescription fillings; and (3) a controller-to-total asthma medication ratio of at least 0.5. We calculated the odds of having an asthma exacerbation in 2003 as a function of performance on each quality metric, adjusting for race, sex, age, and prior outpatient and acute care use for asthma.
RESULTS: Of 90,909 subjects with persistent asthma in California (48.1%) and New York (51.9%), those who obtained at least 1 or at least 4 controller medications had increased likelihood of poor outcomes (adjusted odds ratios, 1.80 [95% CI, 1.73-1.87] and 1.44 [95% CI 1.40-1.48], respectively). Beneficiaries meeting the controller-to-total asthma medication ratio measure were 23.0% less likely to have exacerbations (adjusted odds ratio, 0.77 [95% CI, 0.75-0.80]).
CONCLUSIONS: A higher controller medication ratio indicated a lower likelihood of asthma exacerbations, whereas assessing the number of controller medication-dispensing events was associated with a higher odds of exacerbation.
J Allergy Clin Immunol. 2009 Sep 11.
目的：比较3个基于哮喘质量控制措施和哮喘恶化之间的相关性，以期深入了解哮喘治疗流程与临床效果的相关性。
方法：于2001～2002年在美国加利福尼亚州和纽约，采用采用针对哮喘的医疗保健有效性数据和信息集（HEDIS）标准入选从医疗救助中获益的持续性哮喘患者，纳入该队列研究。我们于2002年评估了的3个哮喘质量指标：（1）至少应用一种控制性药物的当前HEDIS检测；（2）至少4种控制性药物给药；（3）哮喘控制药物和总哮喘治疗药物比率至少0.5。在2003年，校正种族、性别、年龄、门诊患者及急性哮喘处理后，计算哮喘恶化优势比，作为每种质量检测方法的有效性。
结果：在加利福尼亚州（48.1%）和纽约（51.9%）共计90,909名持续性哮喘患者中，采用至少1种或至少4种哮喘控制药物治疗的患者预后较差的可能性增加（校正OR分别为1.80 [95% CI, 1.73-1.87]和1.44 [95% CI 1.40-1.48]）。满足哮喘控制药物与总哮喘治疗药物比率的检测患者，哮喘恶化的可能性减少23％（校正OR为0.77 [95% CI, 0.75-0.80]）。
结论：给予较高比例的哮喘控制药物显示哮喘恶化的可能性较低，但哮喘控制药物数量的增加与哮喘恶化增加相关。
（陈欣 审校）
J Allergy Clin Immunol. 2009 Sep 11.
Process quality measures and asthma exacerbations in the Medicaid population.
Yong PL, Werner RM.
BACKGROUND: Asthma quality assessment often focuses on controller medication use, yet claims-based studies find conflicting associations between this care process and clinical outcomes.
OBJECTIVE: We sought to compare the association between 3 controller-based quality measures and asthma exacerbations to gain better understanding of how processes of care are related to clinical outcomes.
METHODS: Identifying a cohort of Medicaid beneficiaries with persistent asthma by using Healthcare Effectiveness Data and Information Set (HEDIS) criteria for asthma in 2001-2002 in California and New York, we assessed 3 asthma quality metrics in 2002: (1) the current HEDIS measure of at least 1 controller medication filling; (2) at least 4 controller medication prescription fillings; and (3) a controller-to-total asthma medication ratio of at least 0.5. We calculated the odds of having an asthma exacerbation in 2003 as a function of performance on each quality metric, adjusting for race, sex, age, and prior outpatient and acute care use for asthma.
RESULTS: Of 90,909 subjects with persistent asthma in California (48.1%) and New York (51.9%), those who obtained at least 1 or at least 4 controller medications had increased likelihood of poor outcomes (adjusted odds ratios, 1.80 [95% CI, 1.73-1.87] and 1.44 [95% CI 1.40-1.48], respectively). Beneficiaries meeting the controller-to-total asthma medication ratio measure were 23.0% less likely to have exacerbations (adjusted odds ratio, 0.77 [95% CI, 0.75-0.80]).
CONCLUSIONS: A higher controller medication ratio indicated a lower likelihood of asthma exacerbations, whereas assessing the number of controller medication-dispensing events was associated with a higher odds of exacerbation.
J Allergy Clin Immunol. 2009 Sep 11.
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老年哮喘：目前认识及未来方向
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吸入四倍剂量性糖皮质激素预防哮喘恶化：一项随机、双盲、安慰剂对照、平行分组临床试验
