Can primary care and continuity of care prevent asthma- related emergency department use and hospitalizations amongst children?
Notice bibliographique
Résumé
Objective Having a primary care provider and a consistent, continuous relationship with said provider may be important for asthma outcomes. In Québec, children are mainly followed by family physicians in family medicine groups (FMGs), family physicians not part of FMGs, or by pediatricians. We sought to determine 1) whether having a usual provider of primary care was associated with asthma-related emergency department (ED) visits and hospitalization in Québec children with asthma and 2) whether continuity of care with a primary care provider was associated with acute asthma outcomes. Methods This was a population-based retrospective cohort study that used Québec provincial health administrative data from 2010-2013. The population was children diagnosed with asthma, aged 2-16 years old (N=39, 341). The main exposure was the primary care model (FMGs, non-FMGs, or pediatricians, compared to no assigned usual provider of care (UPC)). For those with an assigned UPC, continuity of care was measured by the UPC Index (high, medium, low). The main and secondary outcomes were asthma-related ED visits and hospitalizations, respectively. Multivariate logistic regression analyses were used to test associations between exposures and outcomes.ResultsOverall, 17.4% of children diagnosed with asthma in Québec had no assigned UPC. Compared to no assigned UPC, having a UPC was associated with decreased asthma-related ED visits (Pediatrician Odds Ratio (OR): 0.80, 95% confidence interval (CI) [0.73, 0.89], FMGs OR: 0.84, 95% CI [0.75,0.93], non-FMGs OR: 0.92, 95% CI [0.83, 1.02]) and hospital admissions (Pediatrician OR: 0.67, 95% CI [0.59, 0.76], FMGs OR: 0.83, 95% CI [0.73, 0.94], non-FMGs OR: 0.77, 95% CI [0.67, 0.87]). Children followed by a pediatrician were more likely to have high continuity of care. Continuity of care was not significantly associated with asthma-related ED visits but compared to low continuity, medium or high continuity was associated with decreased asthma-related hospital admissions (Medium OR: 0.81, 95% CI [0.73, 0.90], High OR: 0.72, 95% CI [0.63, 0.82])ConclusionHaving a usual provider of primary care was associated with reduced asthma-related ED visits and hospital admissions. For those who had a UPC, high continuity of care was associated with reduced likelihood of asthma-related hospital admissions.
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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 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 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 ».