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Variations in asthma care by race/ethnicity among children enrolled in a state Medicaid program
Alexandra E Shields1, Catherine Comstock, Kevin B Weiss
1Health Policy Institute, Georgetown Public Policy Institute, Georgetown University, Washington, DC 20007, USA. shieldsa@georgetown.edu
Insights
Hispanic and black children with asthma on Medicaid received different asthma care compared to white children. Targeted efforts are needed to improve care for these underserved populations.
Area of Science:
- Pediatric Healthcare
- Health Disparities
- Asthma Management
Background:
- Asthma affects millions of children, with significant disparities in care and outcomes observed across racial and ethnic groups.
- Medicaid-enrolled children represent a vulnerable population often experiencing barriers to accessing quality healthcare.
- Understanding process-of-care differences is crucial for addressing health inequities in pediatric asthma management.
Purpose of the Study:
- To investigate disparities in the process of asthma care among white, Hispanic, and black children enrolled in Medicaid.
- To identify specific areas of care where racial and ethnic minority children may receive suboptimal asthma management.
Main Methods:
- A retrospective cohort study analyzed 1994 Massachusetts Medicaid claims data for 5773 children (aged 2-18) with asthma.
- Six claims-based process-of-care measures reflecting national asthma guidelines were evaluated.
- Measures included primary/specialty care visits, pharmacotherapy, and follow-up care after emergency department (ED) visits and hospitalizations.
Main Results:
- Hispanic children were less likely to have specialist visits or timely ED follow-up but more likely to have multiple annual visits and less likely to be overprescribed beta-agonists.
- Black children were significantly less likely to receive timely follow-up care after ED visits for asthma.
- No significant racial/ethnic differences were found in anti-inflammatory prescribing or post-hospitalization follow-up care.
Conclusions:
- Significant racial and ethnic differences exist in the process of asthma care within the Medicaid population.
- These care disparities may contribute to differential health outcomes for Hispanic and black children with asthma.
- Interventions should focus on improving specific aspects of asthma care for black and Hispanic children to reduce health inequities.
Objective:
To examine differences in the process of care for Medicaid-enrolled white, Hispanic, and black children with asthma.
Design:
Retrospective cohort study using Medicaid claims data to analyze the process of asthma care in 1994, including all white (non-Hispanic), black (non-Hispanic), and Hispanic children (aged 2-18 years) with asthma in the non-health maintenance organization portion of the Massachusetts Medicaid program (N = 5773). Main outcome measures included performance on 6 claims-based process-of-care measures that reflect national guidelines. Measures addressed primary and specialty care for asthma, appropriate asthma pharmacotherapy, and timely follow-up care after asthma emergency department (ED) visits and hospitalizations.
Results:
Controlling for case mix, provider type, disability status, age, and gender, Hispanic children with asthma were 39% less likely than white children to have a specialist visit for asthma (odds ratio [OR]: 0.61; confidence interval [CI]: 0.46-0.81) and 41% less likely to receive a follow-up visit within 5 days of being seen in the ED for asthma (OR: 0.59; CI: 0.36-0.95). However, Hispanic children received better care in 2 respects. They were 16% more likely than white children to receive a minimum of 2 asthma visits per year (CI: 1.01-1.34) and 27% less likely to be overprescribed beta-agonist medications (OR: 0.73; CI: 0.54-0.99). Black children were 64% less likely than white children to receive timely follow-up care after being seen in the ED for asthma (OR: 0.36; CI: 0.18-0.73). There were no racial/ethnic differences in the prescribing of antiinflammatory medications or timely follow-up care after an asthma hospitalization.
Conclusions:
This study demonstrates important differences in the process of care experienced by racial/ethnic subpopulations within a Medicaid population, which may help explain differential outcomes. Efforts to improve asthma outcomes should target specific areas in which black and Hispanic children may be receiving suboptimal care.
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