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Identifying children at risk of asthma exacerbations: beyond HEDIS
Jonathan Hatoun1, Emily K Trudell, Louis Vernacchio
1Pediatric Physicians' Organization at Children's, 77 Pond Ave, Ste 205C, Brookline, MA 02445.
Insights
A new asthma definition using insurance claims improved detection of pediatric patients at risk for asthma exacerbations. This method offers better sensitivity and specificity than current criteria for population health monitoring.
Area of Science:
- Pediatric Health
- Health Informatics
- Epidemiology
Background:
- Asthma requires continuous population health monitoring due to its cost and variability.
- Current insurance claims-based identification tools for asthma may be too specific.
- Improved methods are needed to identify pediatric patients at risk of asthma exacerbations.
Purpose of the Study:
- To evaluate various asthma definitions for improved detection of pediatric patients at risk of asthma exacerbations.
- To compare the effectiveness of different claims-based asthma identification strategies.
Main Methods:
- Retrospective analysis of private insurance claims for 28,363 pediatric patients (ages 2-18) with 3 years of continuous enrollment.
- Tested multiple definitions using medication fills and diagnosis codes for asthma, wheeze, or cough.
- Calculated sensitivity and specificity, constructing a receiver operating characteristic curve.
Main Results:
- A definition requiring 1+ clinician visits with asthma or wheeze diagnosis over 2 years showed high efficiency (sensitivity 0.78, specificity 0.84).
- The Healthcare Effectiveness Data and Information Set (HEDIS) persistent asthma criteria were less sensitive (0.20) but more specific (0.99).
Conclusions:
- A less restrictive, claims-based definition can enhance the identification of pediatric patients at risk for asthma exacerbations.
- This improved detection method can benefit population health registries and quality measurement.
- Findings suggest moving beyond restrictive criteria like HEDIS for better asthma risk identification.
Objectives:
Asthma is a costly and variable disease necessitating routine population health monitoring. Insurance claims represent all paid pharmacy, diagnostic, outpatient, inpatient, and emergency care; however, current claims-based identification tools may be overly specific. We sought to determine how various definitions of asthma may improve detection of patients at risk of asthma exacerbations.
Study Design:
A statistical analysis of private insurance claims for patients in a pediatric primary care network in Massachusetts.
Methods:
We performed a retrospective statistical analysis for patients aged 2 to 18 years with 3 years of continuous enrollment. Multiple potential definitions were constructed and tested on 2 years of data against their ability to identify patients having an exacerbation in the third year. Definitions tested utilized patterns of medication fills and visits billed with a diagnosis of asthma, wheeze, or cough. We calculated the sensitivity and specificity of each definition and constructed a receiver operating characteristic curve.
Results:
In a cohort of 28,363 patients, a definition identifying patients with 1 or more clinician visits with a diagnosis of asthma or wheeze over 2 years was most efficient in detecting patients with an exacerbation in the subsequent year (sensitivity, 0.78; specificity, 0.84). When tested on the same cohort, the Healthcare Effectiveness Data and Information Set (HEDIS) persistent asthma criteria were less sensitive but more specific (sensitivity, 0.20; specificity, 0.99).
Conclusions:
Population health registries and quality measurement may benefit from using a claims-based definition of pediatric patients at risk of asthma exacerbations that is not as restrictive as the HEDIS persistent asthma criteria.
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01:12Relative Risk