■哮喘指南提倡在哮喘管理中使用护理质量指标(QCI)。为了改善哮喘护理,重要的是要确定有效的QCI是可行的。这项研究旨在评估3个QCI的存在的效果:哮喘教育,哮喘控制测试(ACT)和肺活量测定测试严重加重时间(TTSE)。
■从SingHealthCOPD和哮喘数据集市(SCDM)收集的数据,分析了2015年1月至2020年12月在9家SingHealth综合诊所和新加坡总医院接受治疗的哮喘患者。接受全球哮喘倡议(GINA)步骤3-5治疗的患者,记录了至少1个QCI,以及在首次QCI记录前1年内至少1次严重加重,包括在内。使用多变量Cox回归和准泊松回归模型分析数据。
■共有3849名患者在注册中符合这些标准。有哮喘教育或ACT评估记录的患者的TTSE调整风险比(HR)较低(调整后HR=0.88,P=0.023;调整后HR=0.83,P<0.001)。与肺活量测定相关的调整后HR较高(调整后HR=1.22,P=0.026)。QCI与急诊科(ED)/住院患者没有显着相关。只有哮喘教育和ACT显示多变量分析的加重次数减少(哮喘教育估计:-0.181,P<0.001;ACT估计:-0.169,P<0.001)。QCI对与ED/住院患者就诊相关的恶化次数无显著影响。
■我们的研究表明,哮喘教育和ACT的表现与TTSE增加和恶化次数减少有关。强调在临床实践中确保优质护理的重要性。
UNASSIGNED: Asthma guidelines have advocated for the use of quality-of-care indicators (QCIs) in asthma management. To improve asthma care, it is important to identify effective QCIs that are actionable. This study aimed to evaluate the effect of the presence of 3 QCIs: asthma education, Asthma Control Test (ACT) and
spirometry testing on the time to severe exacerbation (TTSE).
UNASSIGNED: Data collected from the SingHealth COPD and Asthma Data Mart (SCDM), including asthma patients managed in 9 SingHealth polyclinics and Singapore General Hospital from January 2015 to December 2020, were analysed. Patients receiving Global Initiative for Asthma (GINA) Steps 3-5 treatment, with at least 1 QCI recorded, and at least 1 severe exacerbation within 1 year before the first QCI record, were included. Data were analysed using multivariate Cox regression and quasi-Poisson regression models.
UNASSIGNED: A total of 3849 patients in the registry fulfilled the criteria. Patients with records of asthma education or ACT assessment have a lower adjusted hazard ratio (HR) for TTSE (adjusted HR=0.88, P=0.023; adjusted HR=0.83, P<0.001). Adjusted HR associated with
spirometry is higher (adjusted HR=1.22, P=0.026). No QCI was significantly associated with emergency department (ED)/inpatient visits. Only asthma education and ACT showed a decrease in the number of exacerbations for multivariate analysis (asthma education estimate: -0.181, P<0.001; ACT estimate: -0.169, P<0.001). No QCI was significant for the number of exacerbations associated with ED/inpatient visits.
UNASSIGNED: Our study suggests that the perfor-mance of asthma education and ACT was associated with increased TTSE and decreased number of exacerbations, underscoring the importance of ensuring quality care in clinical practice.