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Asthma Quality Measurement and Adverse Outcomes in Medicaid-Enrolled Children
Akilah A Jefferson1,2, Clare C Brown3, Arina Eyimina3
1Department of Pediatrics, Allergy & Immunology Division.
Insights
The asthma medication ratio (AMR) poorly identifies children with asthma at risk for adverse events. New frameworks are needed to improve asthma management and health equity for pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Health Equity
Background:
- The asthma medication ratio (AMR) is a quality measure used to assess asthma care.
- Concerns exist regarding the AMR's utility in identifying pediatric asthma-related adverse events (AAEs).
- Medicaid-enrolled children represent a vulnerable population for asthma management.
Purpose of the Study:
- To evaluate the association between the AMR quality measure and AAEs in Medicaid-enrolled children with asthma.
- To assess the AMR's effectiveness in predicting asthma-related hospitalizations and emergency department visits.
- To examine potential disparities in AMR performance across racial and ethnic subgroups.
Main Methods:
- Utilized the Arkansas All-Payer Claims Database for Medicaid-enrolled children with asthma.
- Applied both restrictive (HEDIS) and nonrestrictive case definitions for asthma.
- Assessed the AMR using traditional dichotomous and expanded categorization, analyzing associations with AAEs via regression models.
Main Results:
- A total of 22,788 children were analyzed; 9.0% experienced AAEs.
- Found a poor correlation between AMR and AAEs, with higher AAE rates (10.5%) in children with AMR ≥0.5 versus AMR <0.5 (8.5%).
- Expanded AMR categorization showed different associations compared to traditional methods, with poorer performance observed in Black children.
Conclusions:
- The AMR demonstrated poor performance in identifying children with asthma at risk for adverse outcomes.
- Findings raise concerns about the AMR's utility in population health management and the limitations of restrictive definitions.
- Emphasized the need for new population health frameworks that incorporate broader considerations to improve asthma management equity and outcomes for children.
Objectives:
To determine the association between the asthma medication ratio (AMR) quality measure and adverse outcomes among Medicaid-enrolled children with asthma in Arkansas, given concerns regarding the utility of the AMR in evaluating pediatric risk of asthma-related adverse events (AAEs).
Methods:
We used the Arkansas All-Payer Claims Database to identify Medicaid-enrolled children with asthma using a nonrestrictive case definition and additionally using the standard Healthcare Effectiveness Data and Information Set (HEDIS) persistent asthma definition. We assessed the AMR using the traditional dichotomous HEDIS AMR categorization and across 4 expanded AMR categories. Regression models assessed associations between AMR and AAE including hospitalization and emergency department utilization, with models conducted overall and by race and ethnicity.
Results:
Of the 22 788 children in the analysis, 9.0% had an AAE (6.7% asthma-related emergency department visits; 3.0% asthma-related hospitalizations). We found poor correlation between AMR and AAE, with higher rates of AAE (10.5%) among children with AMR ≥0.5 compared with AMR <0.5 (8.5%; P < .001), and similar patterns stratified by racial and ethnic subgroups. Expanded AMR categorization revealed notable differences in associations between AMR and AAEs, compared with traditional dichotomous categorization, with worse performance in Black children.
Conclusions:
The AMR performed poorly in identifying risk of adverse outcomes among Medicaid-enrolled children with asthma. These findings underscore concerns of the utility of the AMR in population health management and reliance on restrictive HEDIS definitions. New population health frameworks incorporating broader considerations that accurately identify at-risk children are needed to improve equity in asthma management and outcomes.
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