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Geographic variation of asthma quality measures within and between health plans

Kevin J Dombkowski1, Michael D Cabana, Lisa M Cohn

  • 1Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Mich, USA. kjd@med.umich.edu.

The American Journal of Managed Care
|December 13, 2005
PubMed

Insights

Health plan performance in pediatric asthma care varied significantly across and within regions. Analyzing regional variations is crucial for identifying quality improvement opportunities in asthma management.

Area of Science:

  • Health Services Research
  • Pediatric Pulmonology
  • Health Plan Performance Analysis

Background:

  • Pediatric asthma management adherence to national guidelines is critical for effective treatment.
  • Variations in health plan performance can impact patient outcomes.
  • Geographic regional differences may influence healthcare delivery and quality.

Purpose of the Study:

  • To compare health plan performance in pediatric asthma care across and within geographic regions.
  • To identify variations in adherence to national asthma management guidelines among health plans.
  • To assess the impact of regional differences on pediatric asthma care quality.

Main Methods:

  • Retrospective analysis of administrative claims data from 18 Michigan Medicaid health plans.
  • Study included 3970 children aged 5-18 with persistent asthma, continuously enrolled.
  • Outcome measures included controller medication prescription, outpatient visits, ED visits, and influenza vaccination.

Main Results:

  • Significant variation (P <= .05) in adherence to national asthma guidelines between and within health plans.
  • Proportion of children with controller medications ranged from 66% to 88%; influenza vaccination from 3% to 46%.
  • Plan rankings fluctuated based on guideline measures, with substantial within-plan regional performance disparities observed.

Conclusions:

  • Plan-level assessments of asthma guideline adherence may not fully capture quality improvement needs.
  • Administrative claims data sensitive to regional variations are valuable for identifying and prioritizing quality-improvement opportunities.
  • Tailored, region-specific strategies are likely necessary for optimizing pediatric asthma care within health plans.
Abstract

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