美国康涅狄格州家庭环境评估项目有关的生活质量和成本效益分析
2011/03/24
摘要
背景：国家哮喘教育预防计划(NAEPP)专家小组报告3 (EPR3)的指南强调环境控制有益于哮喘控制，但其有效性相关证据较少。
目的：为研究美国康涅狄格州儿童和成人家庭哮喘干预计划的有效性，本试验组建一个专家小组，研究哮喘患者生活质量指标及预防护理与急性期护理的成本效益。
方法：减少室内哮喘策略(AIRS)项目旨在通过患者宣教和家庭环境评估，减少急性哮喘发作和改善哮喘控制。以2周、3个月和6个月的间隔进行随访。检测的生活质量指标包括：未事先计划的急性期护理次数、由哮喘导致的旷课/工天数、急症吸入治疗次数及无哮喘症状天数。采用反复测量方差分析（ANOVA），检验随访期的生活质量指标与随访前相比是否存在差异。分别将成人和儿童哮喘患者因哮喘门诊就诊和急诊就诊(ED)的开支制成表格，进行成本效益分析。
结果：20%的参与者哮喘控制较好，16%的患者哮喘控制较差，64%的患者哮喘控制极差。在6个月的随访期内，过去1周内，与随访初始相比，未事先计划的急性期护理平均次数、因哮喘而旷课/工天数及急症吸入治疗次数分别下降了87%、82%和74%，而无哮喘症状天数增加了27%。此外，哮喘控制极差的患者比例从随访初的64%下降至随访6个月时的13%。所有变化均具有统计学显著性差异（p < 0.05）。在6个月的随访期内，对于儿童和成人哮喘患者，由于未事先计划的急性期护理次数下降，每100名患者治疗费用净减少$26720 。
结论：在美国康涅狄格州，实施AIRS项目后，显著改善了哮喘患者的生活质量，减少了医疗资源利用和医疗费用。
（苏楠 审校）
J Asthma. 2010 Nov 30. [Epub ahead of print]
Quality-of-Life and Cost-Benefit Analysis of a Home Environmental Assessment Program in Connecticut.
Nguyen KH, Boulay E, Peng J.
Connecticut Department of Public Health, Hartford, CT, USA.
Abstract
Background. The National Asthma Education Prevention Program’s (NAEPP) Expert Panel Report 3 (EPR3) guidelines have stressed the need for environmental control measures for asthma, but there is limited evidence of their efficacy.
Objective. To examine the effectiveness of an in-home asthma intervention program for children and adults in Connecticut, we conducted a panel study to analyze quality-of-life indicators for asthmatic patients and the cost-benefit relationship in preventive care versus acute care.
Methods. The Asthma Indoor Reduction Strategies (AIRS) program was developed to reduce acute asthma episodes and improve asthma control through patient education and a home environmental assessment. Follow-up was conducted at 2-week, 3-month, and 6-month intervals. Measured quality-of-life indicators included number of unscheduled acute care visits, days absent from school/work due to asthma, times rescue inhaler used, and number of symptom-free days. Repeated measures analysis of variance (ANOVA) was used to determine whether significant differences exist in quality-of-life indicators at follow-up compared to that at the initial visit. Cost-benefit analysis was conducted by tabulating costs associated with physician office visits and emergency department (ED) visits due to asthma for children and adults separately.
Results. Twenty percent of participants in the program met the criteria for well-controlled asthma, 16% for not well-controlled asthma, and 64% for very poorly controlled asthma. At 6 months follow-up, the mean number of unscheduled acute care visits, days absent from school/work due to asthma, and times rescue inhaler used in the past week decreased by 87%, 82%, and 74%, respectively, whereas the mean number of symptom-free days increased by 27% compared to the initial visit. Furthermore, the percent of participants with very poorly controlled asthma decreased from 64% at initial visit to 13% at 6 months follow-up. All changes were statistically significant at p < 0.05. A net savings of $26,720 per 100 participants was estimated at 6 months follow-up due to decreases in unscheduled acute care visits for adults and children.
Conclusion. Significant improvement in quality-of-life and decreases in healthcare resource utilization and costs were found after implementation of the AIRS program in Connecticut.
J Asthma. 2010 Nov 30. [Epub ahead of print]
背景：国家哮喘教育预防计划(NAEPP)专家小组报告3 (EPR3)的指南强调环境控制有益于哮喘控制，但其有效性相关证据较少。
目的：为研究美国康涅狄格州儿童和成人家庭哮喘干预计划的有效性，本试验组建一个专家小组，研究哮喘患者生活质量指标及预防护理与急性期护理的成本效益。
方法：减少室内哮喘策略(AIRS)项目旨在通过患者宣教和家庭环境评估，减少急性哮喘发作和改善哮喘控制。以2周、3个月和6个月的间隔进行随访。检测的生活质量指标包括：未事先计划的急性期护理次数、由哮喘导致的旷课/工天数、急症吸入治疗次数及无哮喘症状天数。采用反复测量方差分析（ANOVA），检验随访期的生活质量指标与随访前相比是否存在差异。分别将成人和儿童哮喘患者因哮喘门诊就诊和急诊就诊(ED)的开支制成表格，进行成本效益分析。
结果：20%的参与者哮喘控制较好，16%的患者哮喘控制较差，64%的患者哮喘控制极差。在6个月的随访期内，过去1周内，与随访初始相比，未事先计划的急性期护理平均次数、因哮喘而旷课/工天数及急症吸入治疗次数分别下降了87%、82%和74%，而无哮喘症状天数增加了27%。此外，哮喘控制极差的患者比例从随访初的64%下降至随访6个月时的13%。所有变化均具有统计学显著性差异（p < 0.05）。在6个月的随访期内，对于儿童和成人哮喘患者，由于未事先计划的急性期护理次数下降，每100名患者治疗费用净减少$26720 。
结论：在美国康涅狄格州，实施AIRS项目后，显著改善了哮喘患者的生活质量，减少了医疗资源利用和医疗费用。
（苏楠 审校）
J Asthma. 2010 Nov 30. [Epub ahead of print]
Quality-of-Life and Cost-Benefit Analysis of a Home Environmental Assessment Program in Connecticut.
Nguyen KH, Boulay E, Peng J.
Connecticut Department of Public Health, Hartford, CT, USA.
Abstract
Background. The National Asthma Education Prevention Program’s (NAEPP) Expert Panel Report 3 (EPR3) guidelines have stressed the need for environmental control measures for asthma, but there is limited evidence of their efficacy.
Objective. To examine the effectiveness of an in-home asthma intervention program for children and adults in Connecticut, we conducted a panel study to analyze quality-of-life indicators for asthmatic patients and the cost-benefit relationship in preventive care versus acute care.
Methods. The Asthma Indoor Reduction Strategies (AIRS) program was developed to reduce acute asthma episodes and improve asthma control through patient education and a home environmental assessment. Follow-up was conducted at 2-week, 3-month, and 6-month intervals. Measured quality-of-life indicators included number of unscheduled acute care visits, days absent from school/work due to asthma, times rescue inhaler used, and number of symptom-free days. Repeated measures analysis of variance (ANOVA) was used to determine whether significant differences exist in quality-of-life indicators at follow-up compared to that at the initial visit. Cost-benefit analysis was conducted by tabulating costs associated with physician office visits and emergency department (ED) visits due to asthma for children and adults separately.
Results. Twenty percent of participants in the program met the criteria for well-controlled asthma, 16% for not well-controlled asthma, and 64% for very poorly controlled asthma. At 6 months follow-up, the mean number of unscheduled acute care visits, days absent from school/work due to asthma, and times rescue inhaler used in the past week decreased by 87%, 82%, and 74%, respectively, whereas the mean number of symptom-free days increased by 27% compared to the initial visit. Furthermore, the percent of participants with very poorly controlled asthma decreased from 64% at initial visit to 13% at 6 months follow-up. All changes were statistically significant at p < 0.05. A net savings of $26,720 per 100 participants was estimated at 6 months follow-up due to decreases in unscheduled acute care visits for adults and children.
Conclusion. Significant improvement in quality-of-life and decreases in healthcare resource utilization and costs were found after implementation of the AIRS program in Connecticut.
J Asthma. 2010 Nov 30. [Epub ahead of print]
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老年哮喘患者的宣教：来自美国哮喘调查的结果
