改善因喘恶化而入院的患者的单次维护和缓解疗法
Katherine A Pumphrey1, Jessica K Hart2, Joseph J Zorc2,3
1From the Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
Pediatric quality & safety
|February 25, 2026
概括
现在建议单次维护和缓解疗法 (SMART) 用于患有持续性喘的儿童. 这项质量改进项目成功增加了小儿喘患者出院时的SMART处方,改善了公平护理.
科学领域:
- 儿科肺病学 儿科肺病学
- 质量改进科学 质量改进科学
- 卫生公平研究 卫生公平研究
背景情况:
- 单次维护和缓解疗法 (SMART) 是指导方针推给美国的学龄儿童,控制不良的持续性喘.
- 儿科住院医疗服务提供者对于给高风险喘患者开SMART的处方至关重要.
- 退院时现有的SMART处方率低于最佳水平 (17%),需要针对性的干预措施.
研究的目的:
- 到2023年9月,将符合条件的儿科喘患者在出院时的SMART处方比例从17%提高到40%.
- 确保在不同患者群体 (支付者类型,种族,儿童机会指数) 中 SMART 处方的公平改进.
- 解决SMART处方的主要驱动因素:处方者熟悉,文化,决策支持和后勤.
主要方法:
- 一个质量改进项目,利用10个计划-做-研究-行动周期.
- 干预的重点是教育和临床决策支持,以解决确定的驱动因素.
- 纳入标准:患有吸入控制药物的儿科患者,在12个月内患有喘恶化相关的住院/急诊次数≥2.
主要成果:
- 出院时的SMART处方从17%增加到38%,持续了19个月.
- 这种增长在人口结构层中观察到,包括黑人患者,政府保险患者和儿童机会指数较低的患者.
- 该项目在2021年1月至2023年12月期间为215名独特的儿科患者提供了312次医院接触.
结论:
- 质量改进方法有效增加了小儿喘恶化在出院时的SMART处方.
- 这些干预措施在减少喘护理差异方面取得了成功.
- 在SMART处方中持续的改进有助于在儿童群体中更好地管理喘.
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