Identifying high-risk asthma with utilization data: a revised HEDIS definition.

Area of Science:

• Pediatric Pulmonology
• Health Services Research
• Clinical Informatics

Background:

• The 2006 Healthcare Effectiveness Data and Information Set (HEDIS) definition for high-risk asthma may over-identify patients, potentially diluting case management resources.
• Accurate identification of high-risk pediatric asthma patients is crucial for effective intervention and resource allocation.

Purpose of the Study:

• To develop and validate a revised definition of high-risk asthma in youth.
• To improve the precision of identifying pediatric asthma patients who require intensive case management compared to the existing 2006 HEDIS definition.

Main Methods:

• A two-year claims-based study utilizing cross-sectional phone survey data from 769 youths (aged 11-17) with asthma.
• Compared the 2006 HEDIS criteria (e.g., >1 ED visit, >=1 hospitalization) with a revised definition (e.g., >=1 ED visit, >=1 hospitalization, >=1 oral steroid prescription).
• Analyzed demographic, clinical characteristics, healthcare utilization, and costs for patients identified by each definition.

Main Results:

• The revised definition identified 29% of the sample as high-risk, compared to 67% by the 2006 HEDIS definition.
• Patients identified by the revised definition exhibited greater asthma-related physical health issues and higher medical costs in year 1.
• In year 2, youths classified as high-risk by the revised definition had more emergency department visits and higher oral steroid use.

Conclusions:

• The revised high-risk asthma definition is more parsimonious, identifying approximately half the number of individuals.
• This refined definition demonstrates superior ability in pinpointing pediatric asthma patients with poorly controlled disease in the subsequent year.
• The findings suggest the revised definition is a more effective tool for targeting case management interventions in pediatric asthma populations.