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Estimated effect of asthma case management using propensity score methods
Sylvia Brandt1, Sara Gale, Ira B Tager
1Department of Resource Economics, University of Massachusetts - Amherst, MA 01003, USA. brandt@resecon.umass.edu
Insights
Participation in an asthma intervention increased preventive care use, including vaccinations and controller medications, for children. However, the program did not significantly reduce emergency visits or nebulizer treatments for asthma exacerbations.
Area of Science:
- Public Health
- Health Services Research
- Pediatric Asthma Management
Background:
- Asthma is a significant public health concern, particularly among children.
- Effective asthma management programs are crucial for improving health outcomes and reducing healthcare costs.
- The National Asthma Control Program aimed to improve asthma care through various interventions.
Purpose of the Study:
- To evaluate the treatment effect of participating in an asthma intervention program.
- To estimate the impact of asthma case management on healthcare utilization and preventive care among children.
Main Methods:
- Cross-sectional study design comparing participants and non-participants.
- Propensity score matching was used to create a comparable control group.
- Medicaid claims data were analyzed for healthcare utilization and medication adherence.
Main Results:
- Intervention participants showed increased likelihood of receiving pulmonary illness vaccinations.
- A higher proportion of participants filled prescriptions for asthma controller medications.
- No significant difference was observed in nebulizer treatments or emergency department visits between groups.
Conclusions:
- The asthma intervention successfully increased the uptake of preventive healthcare services.
- The study did not find a statistically significant reduction in healthcare utilization for asthma exacerbations.
- Further research is needed to understand factors influencing the program's overall impact on asthma exacerbations.
Objective:
To estimate the treatment effect of participation in an asthma intervention that was part of the National Asthma Control Program.
Study Design:
Cross-sectional; difference in outcomes between participants and comparable nonparticipants matched by using propensity scores.
Methods:
Data on children who participated in asthma case management (n = 270) and eligible children who did not participate in case management (n = 2742) were extracted from a Medicaid claims database. We constructed measures of healthcare utilization, sociodemographics, and neighborhood characteristics. After creating a comparison group similar to the participants in terms of all characteristics before participation, we estimated the effect of the program on asthma outcomes.
Results:
Participants were more likely to have vaccinations for pulmonary illness (95% confidence interval [CI] = 1.82, 4.81), to fill a prescription for controller medications (95% CI = 1.07, 2.19), and to have a refill for rescue medication (95% CI = 1.07, 2.07) after the program than comparable nonparticipants. There was no statistically significant difference in the number of nebulizer treatments or emergency department visits between the 2 groups.
Conclusions:
The program did increase the use of preventive healthcare by participants. Over the time period we studied, these behaviors did not decrease healthcare utilization for asthma exacerbations. We were unable to discern whether the lack of effect was because of the nature of the program, heterogeneity of the effects, or barriers outside the program's control.
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