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Development and Validation of the Asthma Exacerbation Risk Score Using Claims Data
Jonathan Hatoun1, Emily Trudell Correa2, Andrew J MacGinnitie3
1Pediatric Physicians' Organization at Children's (J Hatoun, ET Correa, and L Vernacchio), Wellesley, Mass; Division of General Pediatrics, Boston Children's Hospital (J Hatoun and L Vernacchio), Boston, Mass; Department of Pediatrics, Harvard Medical School (J Hatoun, AJ MacGinnitie, JM Gaffin, and L Vernacchio), Boston, Mass.
Insights
Identifying high-risk pediatric asthma patients is crucial. The Asthma Exacerbation Risk (AER) score uses insurance claims to predict exacerbations, enabling targeted preventive care for children with asthma.
Area of Science:
- Pediatric pulmonology
- Health services research
- Biostatistics
Background:
- Pediatric asthma is a significant health burden, necessitating efficient identification of high-risk individuals for preventive interventions.
- Insurance claims data offer a comprehensive resource for analyzing healthcare utilization and predicting disease exacerbations.
Purpose of the Study:
- To develop and validate a predictive risk score for asthma exacerbations in pediatric patients.
- To utilize prior healthcare utilization patterns from insurance claims to forecast future exacerbation risk.
Main Methods:
- Retrospective analysis of insurance claims for 28,196 pediatric patients (ages 2-18) with continuous enrollment.
- Stepwise regression analysis to identify 10 key predictors of asthma exacerbation within a 12-month period.
- Development of the Asthma Exacerbation Risk (AER) score by weighting and summing identified predictors.
Main Results:
- Ten predictors were significantly associated with asthma exacerbations, including age, persistent asthma criteria, medication fill patterns, outpatient visit counts, recent exacerbations, and spirometry use.
- The AER score is calculated monthly from claims data.
- The AER score effectively identifies patients requiring interventions, such as asthma home-visiting programs.
Conclusions:
- The AER score provides a reliable method for predicting asthma exacerbation risk in children using readily available insurance claims data.
- This tool facilitates proactive patient management and resource allocation for preventive asthma care programs.
Objective:
Pediatric asthma is a costly and complex disease with proven interventions to prevent exacerbations. Finding the patients at highest risk of exacerbations is paramount given limited resources. Insurance claims identify all outpatient, inpatient, emergency, pharmacy, and diagnostic services. The objective was to develop a risk score indicating the likelihood of asthma exacerbation within the next year based on prior utilization.
Methods:
A retrospective analysis of insurance claims for patients 2 to 18 years in a network in Massachusetts with 3 years of continuous enrollment in a commercial plan. Thirty-six potential predictors of exacerbation in the third year were assessed with a stepwise regression. Retained predictors were weighted relative to their contribution to asthma exacerbation risk and summed to create the Asthma Exacerbation Risk (AER) score.
Results:
In a cohort of 28,196 patients, there were 10 predictors associated with the outcome of having an asthma exacerbation in the next year that depend on age, meeting the Healthcare Effectiveness Data and Information Set persistent asthma criteria, fill patterns of asthma medications and oral steroids, counts of nonexacerbation outpatient visits, an exacerbation in the last 6 months, and whether spirometry was performed. The AER score is calculated monthly from a claims database to identify potential patients for an asthma home-visiting program.
Conclusions:
The AER score assigns a risk of exacerbation within the next 12 months using claims data to identify patients in need of preventive services.
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