Evaluation of Asthma Prescription Measures and Health System Performance Based on Emergency Department Utilization

Bibliographic Data

ID9102898
AuthorsAnne Fuhlbrigge, Anne L Fuhlbrigge (0000-0002-4634-1439, Brigham and Women's Hospital, corresponding author), Vincent J Carey (0000-0003-4046-0063, Brigham and Women's Hospital, corresponding author), R Adams (0000-0001-6254-0385, Harvard University Press, corresponding author), Robert J Adams (0000-0002-5837-908X), Jonathan A Finkelstein (0000-0002-7118-4471, Harvard Pilgrim Health Care), Paula Lozano (0000-0002-3378-5532, Group Health Cooperative), Scott T Weiss (0000-0001-7196-303X, Brigham and Women's Hospital, corresponding author), Kevin B Weiss (0000-0002-4786-2033, General Department of Preventive Medicine)
Year2004
Volume42
Issue5
Pages465-471
Publication date2004-05-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/01.mlr.0000124249.84045.d7
PMID15083107
OpenAlexW2058933290
LanguageEN
Citations received1
References cited18

BACKGROUND: Measures based on the use of either antiinflammatory and/or reliever medications have been used to evaluate clinical performance in asthma. OBJECTIVE: We compared the association between 2 asthma prescription measures (APMs) and subsequent risk of emergency department (ED) asthma visits. DESIGN: We conducted a cross-sectional analysis of automated pharmacy and healthcare utilization data from 3 large geographically diverse managed care organizations. PARTICIPANTS: We studied children, 3 to 15 years of age, with at least 1 encounter for asthma (hospitalization, ED, or ambulatory care), at least 1 dispensing of an asthma medication, and continuous enrollment between June 1996 and July 1997. MEASURES: Two performance measures were derived for patients with persistent asthma: 1) the proportion of individuals who have received controller therapy and 2) the ratio of dispensed controller to dispensed reliever medications. Children with persistent asthma were identified using the Health Employers Data Information System (HEDIS) criteria of the National Committee on Quality Assurance definition. Multivariate logistic regression was used to assess independent effects in models for ED visits. RESULTS: Among children with persistent asthma, the dispensing of a controller was associated with a significantly lower risk of an ED visit as compared with children not dispensed a controller (odds ratio, 0.3; 95% confidence interval, 0.2-0.4). An association between the ratio of controller to reliever dispensing and the risk of subsequent ED visit was also observed, however, the underlying level of reliever dispensing modified the relationship. Among children with persistent asthma, the ratio of controller to reliever dispensing was inversely associated with risk of ED visit among children dispensed or =4 relievers/person-year. CONCLUSION: Among children with persistent asthma, the use of an asthma prescription measure (APM) can help stratify children based on their risk of future adverse events. The HEDIS measure, the dispensing of a controller medication among a population with persistent asthma, and the controller to reliever ratio are associated with the risk of subsequent ED visit. However, the association between the ratio measure and risk for ED visit is modified by the underlying level of reliever dispensing

Ambulatory · Asthma · Confidence interval · Emergency department · Family medicine · Health care · Logistic regression · Medical prescription · Odds ratio · Asthma and respiratory diseases · Emergency Medicine · Health Promotion and Cardiovascular Prevention · Internal Medicine · Medication Adherence and Compliance · Medicine · Pharmacy · Pediatrics