Follow-Up Care After an Emergency Department Visit for Asthma and Subsequent Healthcare Utilization in a Universal-Access Healthcare System
Notice bibliographique
Résumé
To describe the follow-up care for asthmatic patients within 28 days of an emergency department (ED) visit and its association with ED revisits and hospital admissions in the subsequent year.In this study, 29 391 children with asthma between the ages of 2 and 17 treated in an ED in Ontario, Canada, between April 16, 2006, and February 28, 2009, had their chart reviewed in a population-based retrospective cohort study. Multiple linked health administrative data sets available through the Institute for Clinical Evaluative Sciences were used to gather data.Data were collected by using the National Ambulatory Care Reporting System, Canadian Institute for Health Information Discharge Abstract Database, and Ontario Health Insurance Plan claims database to identify ED visits, hospital admissions, and outpatient visits, respectively. Only children with preexisting asthma were chosen for the study. The primary and secondary outcomes were the number of children having an ED visit and those having a hospital admission for asthma within 29 to 365 days, respectively. Statistical analysis was done by using SAS (SAS Institute, Inc, Cary, NC) for UNIX.Of the 29 391 children, 32.8% had a follow-up, 22.1% had an ED revisit, and 2.7% had a hospital admission. Having a follow-up visit was not found to be associated with ED revisit or hospitalizations (hazard ratio, 0.98; 95% confidence interval, 0.93–1.03 and hazard ratio, 1.06; 95% confidence interval, 0.92–1.23, respectively). Younger children, those who were in the lower income quintile, and those with more severe acute or chronic asthmatics at the time of ED visits were more likely to have ED revisits and hospitalizations. Other characteristics such as number of visits and type of physician providing care were not associated with outcomes.Follow-up care was not accessed after an ED visit for asthmatic patients even in a universal health care setting. Those that did have follow-up had no association with reduced ED revisits and hospitalizations in the subsequent year.This study highlights the discrepancy between the factors we usually think are associated with good follow-up care for asthmatic patients presenting to the ED and what actually happens. Even with universal health care and accessibility, poor follow-up outcomes can still occur, thus it is important to work toward identifying other factors that have a greater impact on follow-up, ED revisits, and hospitalizations. Ultimately identifying these factors can help us to better manage and control our asthmatic patients.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».