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Acute severe asthma: Outcome and Medicaid insurance
Susan L. Bratton1, Joan S. Roberts, R. Scott Watson
1Department of Pediatrics, University of Michigan School of Medicine (SLB, MDC); the Department of Pediatrics, University of Washington School of Medicine; and the Department of Anesthesiology and Pediatric Critical Care, PIttsburgh School of Medicine.
Insights
Children with Medicaid insurance experienced longer intensive care stays and higher rates of mechanical ventilation for asthma exacerbations. This highlights disparities in asthma care for economically disadvantaged children.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Asthma management
Background:
- Economically disadvantaged children often receive suboptimal preventive asthma care and increased inpatient services.
- Limited research exists on the impact of insurance status on severe asthma exacerbations in pediatric intensive care.
- Understanding these disparities is crucial for improving asthma outcomes in vulnerable populations.
Purpose of the Study:
- To investigate the association between Medicaid insurance and the severity of illness, resource utilization, and outcomes among children admitted to pediatric intensive care units for asthma.
- To compare outcomes for children with Medicaid versus those with commercial or health maintenance organization insurance.
Main Methods:
- Retrospective cohort study utilizing data from the Pediatric Intensive Care Evaluations database (May 1995-February 2000).
- Inclusion criteria: primary asthma diagnosis requiring intensive care.
- Analysis of demographic and clinical data, including insurance status, severity of illness (Pediatric Risk of Mortality III), and length of stay.
Main Results:
- Twenty-six percent of the pediatric asthma patients studied had Medicaid insurance.
- Medicaid-insured children showed a higher incidence of mechanical ventilation (22%) compared to commercial (15%) or health maintenance organization (16%) insurance.
- After adjusting for illness severity, Medicaid insurance was significantly linked to longer intensive care unit (ICU) and hospital stays, and prolonged ventilator support.
Conclusions:
- Asthmatic children with Medicaid insurance experienced significantly longer ICU and hospitalizations and a greater likelihood of requiring mechanical ventilation.
- These findings suggest healthcare disparities in asthma management and outcomes for economically disadvantaged children.
- Further research is warranted to explore differences in outcomes and resource utilization for this population.
Abstract:
OBJECTIVE: Economically disadvantaged children receive less preventive asthma care and more inpatient care. Studies have not evaluated the association of insurance status on children with severe exacerbations. We evaluated differences in severity of illness, resource use, and outcome associated with Medicaid insurance among children receiving intensive care for asthma. DESIGN: Retrospective cohort study. SETTING: Fourteen American pediatric intensive care units participating in the Pediatric Intensive Care Evaluations database. Methods: Patients with a primary diagnosis of asthma treated from May 1995 to February 2000 were identified. Demographic information and clinical data were evaluated to determine whether there was an association between Medicaid insurance, severity of illness, and length of stay. RESULTS: Twenty-six percent of the children had Medicaid insurance; 22% of children with Medicaid insurance received mechanical ventilation compared with 15% of those with commercial insurance and 16% in a health maintenance organization. After adjustment for severity of illness (Pediatric Risk of Mortality III and use of invasive therapies), Medicaid insurance was significantly associated with increased length of stay in the intensive care unit and hospital. Among children who received mechanical ventilation, patients with Medicaid also received ventilator support significantly longer. CONCLUSIONS: Asthmatic children receiving Medicaid had longer pediatric intensive care unit and hospital stays and an increased risk of mechanical ventilation compared with asthmatic children with commercial or health maintenance organization insurance. Further studies are needed to evaluate differences in outcome and resource utilization for economically disadvantaged asthmatic children.
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