Asthma surveillance using Medicaid administrative data: a call for a national framework.

Connecticut, Michigan, and New York have successfully used Medicaid administrative data to conduct surveillance of asthma prevalence, related health service utilization and costs, and quality of asthma care. Since these assessments utilize beneficiary-level data, a wide range of population-based summaries is feasible. Opportunities exist to build upon the collective experiences of these three states to establish a national framework for asthma surveillance using Medicaid administrative data. This framework could be designed to respond to each state's unique data considerations and asthma management priorities, while establishing standardized criteria to enhance the comparability of asthma surveillance data among states. Importantly, a common asthma case definition using comparable methods is necessary to enable comparisons of prevalence estimates between states. Case definitions that could serve as the foundation for such a framework are presented. Mechanisms to foster sharing of methodologies and experiences will be instrumental for broad implementation across states. This collaboration will be of increasing importance as states experience mounting financial pressures due to increasing Medicaid enrollment and dwindling resources.

Variation in emergency department wait times for children by race/ethnicity and payment source.

OBJECTIVE: To quantify the variation in emergency department (ED) wait times by patient race/ethnicity and payment source, and to divide the overall association into between- and within-hospital components. DATA SOURCE: 2005 and 2006 National Hospital Ambulatory Medical Care Surveys. STUDY DESIGN: Linear regression was used to analyze the independent associations between race/ethnicity, payment source, and ED wait times in a pooled cross-sectional design. A hybrid fixed effects specification was used to measure the between- and within-hospital components. DATA EXTRACTION METHODS: Data were limited to children under 16 years presenting at EDs. PRINCIPAL RESULTS: Unadjusted and adjusted ED wait times were significantly longer for non-Hispanic black and Hispanic children than for non-Hispanic white children. Children in EDs with higher shares of non-Hispanic black and Hispanic children waited longer. Moreover, Hispanic children waited 10.4 percent longer than non-Hispanic white children when treated at the same hospital. ED wait times for children did not vary significantly by payment source. CONCLUSIONS: There are sizable racial/ethnic differences in children's ED wait times that can be attributed to both the racial/ethnic mix of children in EDs and to differential treatment by race/ethnicity inside the ED.

Childhood injuries in Connecticut's Medicaid managed care program.

This study describes childhood injuries and injury-related care using encounter data from a Medicaid managed care program. Enrollment and encounter data for federal fiscal year 2000 were used to identify children who received treatment for an injury, to identify risk factors, and to describe injury-related care. Twenty percent of children were treated for an injury. Preschool-age children and adolescents, males, whites, and residents of nonurban areas were at greatest risk. Sixty percent of injured children received emergency care or were hospitalized. Length of hospital stay for treatment of injuries was 33 percent longer than admissions for other conditions. E-codes were rarely reported. One of five children in Connecticut's Medicaid managed care program was treated for an injury in a one-year period. Medicaid managed care data can be used to determine the percentage of children who experience injuries, to identify risk factors, and to describe injury-related care.

Well-baby care in Connecticut's Medicaid managed-care program.

OBJECTIVES: 1) To describe well-baby care in Connecticut's Medicaid managed-care program; 2) to determine the effect of well-baby care on emergency care or hospitalization for ambulatory care-sensitive conditions. DESIGN: Retrospective cohort study. METHODS: Babies born between January 1 and March 31, 2000 who were continuously enrolled for the first year of life were identified (n = 2,054). Encounter data were searched for timely well-baby visits and for emergency care or hospitalization for selected conditions. RESULTS: Thirty-four percent of infants received five or more timely visits during the first year of life. African American and Hispanic babies were less likely than white babies to have had all the recommended care (OR = 0.49, 95% CI: 0.37, 0.63; OR = 0.53, 95% CI: 0.41, 0.69; respectively). Being up-to-date with well-baby care was not associated with a reduced likelihood of emergency care (OR = 0.89; 95% CI: 0.72, 1.09) or hospitalization (OR = 1.23; 95% CI: 0.83, 1.34). CONCLUSION: Most babies did not get timely care. Well-baby care was not associated with reduced use of emergency care or hospitalization for ambulatory care-sensitive conditions.