在哮喘患儿中，医疗之家的质量与校内外活动间的关系
2010/11/04
摘要
目的：在哮喘患儿中研究医疗之家质量与日常生活体验指标的相关性。
方法：从2007年国家儿童健康调查（NSCH）中选取代表性的哮喘患儿，年龄6～17岁（n = 6357），评价医疗之家质量与日常生活经验间的关系。对5个医疗之家特征（接近性、持续性、全面性、以家庭为中心的治疗、治疗协调）单独或总体与学校内相关指标（误学天数、父母与儿童接触的问题、留级）及课外活动参与（体力活动、运动、社区服务或志愿者活动）之间的关系进行研究。
结果：个体特征校正前后，健康保险状态、家庭环境、邻居变化、哮喘严重程度、总体医疗之家评分与更多锻炼天数（beta = 0.10, p <0.05）和更有可能参与社区服务或志愿者工作（OR = 1.16, CI: 1.02-1.31）相关。此外，即使在校正后，医疗之家的特征（接近性、全面性和以家庭为中心的治疗）与6个学校参与指标中的三个相关，且与课外活动的参与也相关。
结论：医疗之家质量，特别是接近性、全面性、以家庭为中心的治疗，与哮喘患儿的日常生活经验正相关。改善上述初级治疗相关部分，则有助于改善儿童慢性疾病和生活质量。
（陈欣 审校）
J Asthma. 2010 Sep 13. [Epub ahead of print]
Relationship of medical home quality with school engagement and after-school participation among children with asthma.
Stevens GD, Pickering TA, Laqui SA.
Department of Family Medicine, Center for Community Health Studies, University of Southern California Keck School of Medicine, Alhambra, California, USA.
Abstract
Objectives: To examine the relationship between medical home quality and measures of daily life experiences among children with asthma.
Methods: A nationally representative sample of children from the 2007 National Survey of Children’s Health (NSCH), aged 6-17 years (n = 6357), who have asthma was used to assess the relationship of a quality medical home and its features with their daily life experiences. Five medical home features - access, continuity, comprehensiveness, family-centered care, and coordination of care - were examined individually and in total in relation to measures of school engagement (missed school days, parents contacted about problems with the child, repeating a grade since kindergarten) and after-school activity participation (physical activity, sports participation, and community service or volunteer work).
Results: Before and after adjustment for personal characteristics, health insurance status, family environment, neighborhood variables, and asthma severity, total medical home score was associated with more days exercised [beta (B) = 0.10, p < .05] and a greater likelihood of having performed community service or volunteer work [odds ratio (OR) = 1.16, CI: 1.02-1.31]. Additionally, the medical home features of access, comprehensiveness, and family-centered care remained favorably associated with three of the six measures of school engagement and after-school activity participation, even after adjustment.
Conclusion: Medical home quality - particularly the features of access, comprehensiveness, and family-centered care - is positively associated with the daily life experiences of children with asthma. Working to enhance these aspects of primary care might be one place to start in improving the management of children’s chronic conditions and their quality of life.
J Asthma. 2010 Sep 13. [Epub ahead of print]
目的：在哮喘患儿中研究医疗之家质量与日常生活体验指标的相关性。
方法：从2007年国家儿童健康调查（NSCH）中选取代表性的哮喘患儿，年龄6～17岁（n = 6357），评价医疗之家质量与日常生活经验间的关系。对5个医疗之家特征（接近性、持续性、全面性、以家庭为中心的治疗、治疗协调）单独或总体与学校内相关指标（误学天数、父母与儿童接触的问题、留级）及课外活动参与（体力活动、运动、社区服务或志愿者活动）之间的关系进行研究。
结果：个体特征校正前后，健康保险状态、家庭环境、邻居变化、哮喘严重程度、总体医疗之家评分与更多锻炼天数（beta = 0.10, p <0.05）和更有可能参与社区服务或志愿者工作（OR = 1.16, CI: 1.02-1.31）相关。此外，即使在校正后，医疗之家的特征（接近性、全面性和以家庭为中心的治疗）与6个学校参与指标中的三个相关，且与课外活动的参与也相关。
结论：医疗之家质量，特别是接近性、全面性、以家庭为中心的治疗，与哮喘患儿的日常生活经验正相关。改善上述初级治疗相关部分，则有助于改善儿童慢性疾病和生活质量。
（陈欣 审校）
J Asthma. 2010 Sep 13. [Epub ahead of print]
Relationship of medical home quality with school engagement and after-school participation among children with asthma.
Stevens GD, Pickering TA, Laqui SA.
Department of Family Medicine, Center for Community Health Studies, University of Southern California Keck School of Medicine, Alhambra, California, USA.
Abstract
Objectives: To examine the relationship between medical home quality and measures of daily life experiences among children with asthma.
Methods: A nationally representative sample of children from the 2007 National Survey of Children’s Health (NSCH), aged 6-17 years (n = 6357), who have asthma was used to assess the relationship of a quality medical home and its features with their daily life experiences. Five medical home features - access, continuity, comprehensiveness, family-centered care, and coordination of care - were examined individually and in total in relation to measures of school engagement (missed school days, parents contacted about problems with the child, repeating a grade since kindergarten) and after-school activity participation (physical activity, sports participation, and community service or volunteer work).
Results: Before and after adjustment for personal characteristics, health insurance status, family environment, neighborhood variables, and asthma severity, total medical home score was associated with more days exercised [beta (B) = 0.10, p < .05] and a greater likelihood of having performed community service or volunteer work [odds ratio (OR) = 1.16, CI: 1.02-1.31]. Additionally, the medical home features of access, comprehensiveness, and family-centered care remained favorably associated with three of the six measures of school engagement and after-school activity participation, even after adjustment.
Conclusion: Medical home quality - particularly the features of access, comprehensiveness, and family-centered care - is positively associated with the daily life experiences of children with asthma. Working to enhance these aspects of primary care might be one place to start in improving the management of children’s chronic conditions and their quality of life.
J Asthma. 2010 Sep 13. [Epub ahead of print]
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哮喘自我管理和生活质量中的知识、态度、自我效能
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在医疗服务短缺人群中采用信息技术减少哮喘治疗差异：初步研究
