Process quality measures and asthma exacerbations in the Medicaid population

• Published in: Journal of allergy and clinical immunology Vol. 124; no. 5; pp. 961 - 966
• Main Authors: Yong, Pierre L., Werner, Rachel M.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2009; Elsevier; Elsevier Limited
• Subjects: Adult; Age; Allergy and Immunology; Anti-Asthmatic Agents - therapeutic use; Asthma; Asthma - drug therapy; Asthma - immunology; Beneficiaries; Biological and medical sciences; Chronic obstructive pulmonary disease, asthma; Cohort Studies; Comorbidity; Disease Progression; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Healthcare Effectiveness Data and Information Set; Hospitals; Humans; Immunopathology; Male; Medicaid; Medical sciences; Middle Aged; Mortality; Older people; Pneumology; Population; Prescriptions; quality of care; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; United States; United States; North America; America; United States > US; Healthcare Effectiveness Data and Information Set; NCQA; OR; HEDIS; Medicaid; quality of care; Asthma; ED; Emergency department; Odds ratio; National Committee for Quality Assurance; Human; Lung disease; Health insurance; Immunopathology; Respiratory disease; Health; Information; Care; Exacerbation; Immunology; Efficiency; Quality; Bronchus disease; Obstructive pulmonary disease
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2009.07.027

Asthma quality assessment often focuses on controller medication use, yet claims-based studies find conflicting associations between this care process and clinical outcomes. We sought to compare the association between 3 controller-based quality measures and asthma exacerbations to gain better understanding of how processes of care are related to clinical outcomes. Identifying a cohort of Medicaid beneficiaries with persistent asthma by using Healthcare Effectiveness Data and Information Set (HEDIS) criteria for asthma in 2001–2002 in California and New York, we assessed 3 asthma quality metrics in 2002: (1) the current HEDIS measure of at least 1 controller medication filling; (2) at least 4 controller medication prescription fillings; and (3) a controller-to-total asthma medication ratio of at least 0.5. We calculated the odds of having an asthma exacerbation in 2003 as a function of performance on each quality metric, adjusting for race, sex, age, and prior outpatient and acute care use for asthma. Of 90,909 subjects with persistent asthma in California (48.1%) and New York (51.9%), those who obtained at least 1 or at least 4 controller medications had increased likelihood of poor outcomes (adjusted odds ratios, 1.80 [95% CI, 1.73–1.87] and 1.44 [95% CI 1.40–1.48], respectively). Beneficiaries meeting the controller-to-total asthma medication ratio measure were 23.0% less likely to have exacerbations (adjusted odds ratio, 0.77 [95% CI, 0.75-0.80]). A higher controller medication ratio indicated a lower likelihood of asthma exacerbations, whereas assessing the number of controller medication–dispensing events was associated with a higher odds of exacerbation.