Association of quality-of-care indicators with asthma outcomes: A retrospective observational study for asthma care in Singapore.

Autor:	Lam SSW; Duke-NUS Medical School, National University of Singapore, Singapore.; Health Services and Systems Research, Duke-NUS Medical School, Singapore.; Health Services Research Centre, Singapore Health Services, Singapore.; Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore.; Lee Kong Chian School of Business, Singapore Management University, Singapore., Chen J; Duke-NUS Medical School, National University of Singapore, Singapore., Wu JT; Duke-NUS Medical School, National University of Singapore, Singapore.; Health Services and Systems Research, Duke-NUS Medical School, Singapore.; Health Services Research Centre, Singapore Health Services, Singapore.; Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore., Lee CF; Duke-NUS Medical School, National University of Singapore, Singapore., Ragavendran N; Duke-NUS Medical School, National University of Singapore, Singapore.; Health Services and Systems Research, Duke-NUS Medical School, Singapore.; Health Services Research Centre, Singapore Health Services, Singapore.; Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore., Ong MEH; Duke-NUS Medical School, National University of Singapore, Singapore.; Health Services and Systems Research, Duke-NUS Medical School, Singapore.; Health Services Research Centre, Singapore Health Services, Singapore.; Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore., Tan NC; Duke-NUS Medical School, National University of Singapore, Singapore.; SingHealth Polyclinics, SingHealth, Singapore., Loo CM; Duke-NUS Medical School, National University of Singapore, Singapore.; Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore., Matchar DB; Duke-NUS Medical School, National University of Singapore, Singapore.; Department of Internal Medicine (General Internal Medicine), Duke University Medical School, Durham, North Carolina, US., Koh MS; Duke-NUS Medical School, National University of Singapore, Singapore.; Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
Jazyk:	angličtina
Zdroj:	Annals of the Academy of Medicine, Singapore [Ann Acad Med Singap] 2023 Oct 30; Vol. 52 (10), pp. 497-509. Date of Electronic Publication: 2023 Oct 30.
DOI:	10.47102/annals-acadmedsg.2023151
Abstrakt:	Introduction: 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). Method: 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. Results: 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. Conclusion: 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. Competing Interests: MSK reports grant support from Astra-Zeneca, outside the submitted work. The SCDM used in this study is funded by the GlaxoSmithKline plc (study number PRJ3057). Apart from these, all authors declare that they have no other competing interest.
Databáze:	MEDLINE
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