儿童哮喘联线（Child Asthma Link Line）：联合启动的、基于电话随访的哮喘患儿综合
2010/07/06
摘要
背景：儿童哮喘是一种复杂的慢性疾病，其临床处理具有一定挑战性，治疗上也存在诸多差异。许多来自医学、社会心理学以及医疗体系的因素都与儿童哮喘这一高发疾病难以控制的现状有关，结果导致过多急诊就诊和住院治疗。近期国家指南强调提高社区医疗机构的主动性，来缓解上述难题。2001开始美国费城联合抗哮喘同盟启动此项以电话随访为基础的治疗协作和系统整合项目（儿童哮喘联线）。本研究通过检测患病率使用标记物，评价该系统模式在改善哮喘处理中的有效性。
背景：儿童哮喘是一种复杂的慢性疾病，其临床处理具有一定挑战性，治疗上也存在诸多差异。许多来自医学、社会心理学以及医疗体系的因素都与儿童哮喘这一高发疾病难以控制的现状有关，结果导致过多急诊就诊和住院治疗。近期国家指南强调提高社区医疗机构的主动性，来缓解上述难题。2001开始美国费城联合抗哮喘同盟启动此项以电话随访为基础的治疗协作和系统整合项目（儿童哮喘联线）。本研究通过检测患病率使用标记物，评价该系统模式在改善哮喘处理中的有效性。
方法：医疗组织管理机构对2003年接受该联线干预的59名儿童资料及236位未接受该系统干预的对应儿童资料进行比较。两组儿童年龄在3～12岁之间，2003年两组在急诊就诊次数、年龄、性别和种族上相匹配。本研究中主要转归变量为急诊就诊次数、住院治疗次数和后续的随访（2004年）。
结果：联线干预的儿童相对于配对儿童，随访期间的住院治疗次数显著降低（P=0.02）。联线干预组儿童在随访期间大部分倾向于门诊就诊（P=0.045）。此外，2003年有多次急诊就诊的联线干预儿童2004年急诊就诊次数明显减少（P=0.046）。
结论：此项合作开发的、基于电话随访的、系统水平干预措施能显著影响儿童哮喘的发病，后者通过住院次数和急诊就诊次数这些终点指标来评价。以电话为基础的综合治疗干预是处理儿童哮喘和其他慢性疾病的一项经济有效的措施。
（林江涛 审校）
Coughey K, et al. J Asthma. 2010 Apr;47(3):303-309.
The Child Asthma Link Line: a coalition-initiated, telephone-based, care coordination intervention for childhood asthma.
Coughey K, Klein G, West C, Diamond JJ, Santana A, McCarville E, Rosenthal MP.
Department of Research and Evaluation, Public Health Management Corporation, Philadelphia, Pennsylvania, USA.
Abstract
BACKGROUND: Childhood asthma is a complex chronic disease that poses significant challenges regarding management, and there is evidence of disparities in care. Many medical, psychosocial, and health system factors contribute to recognized poor control of this most prevalent illness among children, with resultant excessive use of emergency departments and hospitalizations for care. Recent national guidelines emphasize the need for community-based initiatives to address these critical issues. To address health system fragmentation and impact asthma outcomes, the Philadelphia Allies Against Asthma coalition developed and implemented the Child Asthma Link Line, a telephone-based care coordination and system integration program, which has been in operation since 2001. This study evaluates the effectiveness of the Child Asthma Link Line integration model to improve asthma management by measuring utilization markers of morbidity.
METHODS: Medicaid Managed Care Organization claims data for 59 children who received the Link Line intervention in 2003 are compared to a matched sample of 236 children who did not receive the Link Line intervention. Children in the two study groups are ages 3 through 12 years and matched on 2003 emergency department visits, age, gender, and race/ethnicity. Primary outcome variables analyzed in this study are emergency department visits, hospitalizations, and office visit claims from the follow-up year (2004).
RESULTS: Link Line intervention children were significantly less likely to have follow-up hospitalizations than matched sample children (p = .02). Children enrolled in the Link Line were also more likely to attend outpatient office visits in the follow-up year (p = .045). In addition, Link Line children with multiple emergency department visits in 2003 were significantly less likely to have an emergency department visit in 2004 (p = .046).
CONCLUSION: This coalition-developed, telephone-based, system-level intervention had a significant impact on childhood asthma morbidity as measured by utilization endpoints of follow-up hospitalizations and emergency department visits. Telephone-based care coordination and service integration may be a viable and economic way to impact childhood asthma and other chronic diseases.
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在哮喘管理中医患合作的障碍：患者的经验
