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Association of Allergy Specialty Care and Asthma Outcomes for Medicaid-Enrolled Children
Melanie Boyd1, Arina Eyimina1, Clare C Brown1
1Department of Health Policy and Management, University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health, Little Rock, AR.
Insights
Children with asthma in Arkansas Medicaid who saw allergy specialists had fewer asthma-related adverse events. Allergy care improves asthma management and reduces emergency visits and hospitalizations.
Area of Science:
- Pediatric Allergy and Immunology
- Public Health
- Health Services Research
Background:
- Asthma is a significant chronic respiratory condition in children.
- Effective asthma management is crucial for reducing adverse health outcomes.
- The role of specialist care in pediatric asthma management within Medicaid populations requires evaluation.
Purpose of the Study:
- To compare the effectiveness of allergy specialist care for children with asthma.
- To assess the impact of allergy specialist visits on asthma-related adverse events (AAEs) in Medicaid-enrolled children.
- To inform asthma health management programs with evidence-based recommendations.
Main Methods:
- Utilized the Arkansas All-Payers Claims Database for Medicaid-enrolled children with asthma.
- Employed propensity score matching to compare children with and without allergy specialist visits.
- Analyzed differences in asthma-related adverse events (emergency department visits/hospitalizations) in the subsequent year using multivariable logistic regression.
Main Results:
- In the matched sample, 10.1% of children experienced an asthma-related adverse event (AAE).
- Children seeing an allergy specialist had 21.0% lower odds of AAEs (aOR: 0.79; 95% CI: 0.63, 0.98).
- The association remained significant after adjusting for potential confounders.
Conclusions:
- Allergy specialist care is associated with a reduced likelihood of asthma-related adverse events in pediatric Medicaid patients.
- Integrating guideline-based recommendations for allergy specialist care into asthma management programs is recommended.
- This study highlights the value of specialized care in improving asthma outcomes for vulnerable pediatric populations.
Objective:
To evaluate the comparative effectiveness of allergy specialist care for children with asthma enrolled in the Arkansas Medicaid program.
Study Design:
We used the Arkansas All-Payers Claims Database to identify Medicaid-enrolled children with asthma who had an allergy specialist visit in 2018. These children were propensity score matched to children without an allergy specialist visit to evaluate differences in asthma-related adverse events (AAEs), specifically emergency department visits and/or hospitalizations in 2019. Multivariable logistic regression was used to assess the association between allergy specialist care in 2018 and AAEs in 2019.
Results:
Prior to matching, a higher percentage of children with an allergy specialist visit had persistent asthma, were atopic, and received influenza vaccination. In the matched sample, 10.1% of identified patients experienced an AAE in 2019. Adjusted analysis showed 21.0% lower odds of AAEs (aOR: 0.79; 95% CI: 0.63, 0.98) in 2019 for children with an allergy specialist visit (n = 2964) in 2018 compared with those without an allergy specialist visit (ME: 9.1% vs 11.0%; P = .04).
Conclusions:
Children with asthma enrolled in Arkansas Medicaid who saw an allergy specialist were less likely to have an AAE. Asthma quality metrics developed using guideline-based recommendations for allergy specialist care should be considered for asthma health management programs.
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