Using Medicaid claims to identify children with asthma

Area of Science:

• Public Health
• Health Informatics
• Pediatric Asthma Research

Background:

• Accurate identification of children with asthma is crucial for targeted health interventions.
• Statewide immunization information systems offer a potential platform for identifying pediatric asthma cases.

Purpose of the Study:

• To evaluate the accuracy of using administrative data from state programs to identify children with asthma within a statewide immunization information system.
• To determine how different asthma case definitions impact identification accuracy.

Main Methods:

• Children aged 2-18 were categorized using Michigan administrative data (2005-2006) into three groups: Children's Special Health Care Services (CSHCS) asthma diagnosis, asthma medication claims (Rx), or asthma diagnosis codes without medication (Dx).
• A random sample from each group underwent telephone interviews with parents to confirm physician diagnosis, symptoms, and healthcare utilization.
• The primary outcome was the positive predictive value (PPV) of parent-reported physician diagnosis and asthma severity.

Main Results:

• Parental confirmation of physician-diagnosed asthma was high (83%) among identified cases.
• The PPV varied significantly across case definitions: CSHCS (100%), Rx (91%), and Dx (73%).
• Asthma severity was similar for CSHCS and Rx cases but lower for Dx cases.

Conclusions:

• Administrative data, particularly CSHCS and Rx case definitions, can accurately identify children with asthma.
• This method is feasible for Medicaid programs and health plans to identify children for targeted public health initiatives, such as influenza vaccination reminders.