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How well do the HEDIS asthma inclusion criteria identify persistent asthma?
David M Mosen1, Eric Macy, Michael Schatz
1Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR 97232, USA. david.m.mosen@kpchr.org
The American Journal of Managed Care
|October 20, 2005
Summary
Many patients in the Health Plan Employer Data and Information Set (HEDIS) asthma cohort do not consistently meet persistent asthma criteria annually. More years qualifying for HEDIS persistent asthma increased medication and healthcare utilization, suggesting suboptimal criteria.
Area of Science:
- Pulmonary Medicine
- Health Services Research
- Healthcare Quality Measurement
Background:
- The Health Plan Employer Data and Information Set (HEDIS) uses specific criteria to define persistent asthma.
- Consistent identification of persistent asthma is crucial for accurate cohort analysis and quality assessment.
- Previous studies have not fully evaluated the year-to-year consistency of HEDIS persistent asthma criteria.
Purpose of the Study:
- To assess the year-to-year consistency of HEDIS persistent asthma inclusion criteria.
- To investigate the association between the duration of HEDIS persistent asthma qualification and medication/resource utilization.
Main Methods:
- Retrospective observational study of 132,414 patients in a large healthcare program (1999-2002).
- Patients included in at least one HEDIS persistent asthma cohort with continuous coverage.
- Analysis of medication, emergency department, and hospital use in 2002 using electronic claims and pharmacy data.
Main Results:
- Nearly half (47.9%) of patients qualified for HEDIS persistent asthma in only one year.
- 40.8% qualified for at least two consecutive years, and 28.2% for three or more.
- Increased consecutive years of HEDIS qualification correlated with higher use of short-acting beta-agonists, inhaled corticosteroids, emergency visits, and hospitalizations.
Conclusions:
- A substantial proportion of the HEDIS persistent asthma cohort lacks year-to-year consistency.
- The current one-year qualification period and administrative case definition may be suboptimal for identifying persistent asthma.
- Further research is needed to validate and potentially refine HEDIS criteria for persistent asthma.
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