The HEDIS Medication Management for People with Asthma Measure is Not Related to Improved Asthma Outcomes.

BACKGROUND: A new Healthcare Effectiveness Data and Information Set (HEDIS) asthma quality-of-care measure designed to quantify patient adherence to asthma controller medication has been implemented. The relationship between this measure and asthma outcomes is unknown. OBJECTIVE: To examine the relationship between the HEDIS Medication Management for people with Asthma (MMA) measure and asthma outcomes. METHODS: Administrative data identified 30,040 patients who met HEDIS criteria for persistent asthma during 2012. These patients were classified as compliant or noncompliant with the MMA measure at the 75% and 50% threshold, respectively. The association between MMA compliance in 2012 and asthma outcomes in 2013 was determined. RESULTS: Patients who were 75% or 50% MMA compliant in 2012 showed no clinically meaningful difference in asthma-related hospitalizations, emergency department visits, or rescue inhaler dispensing in 2013 compared with those who were noncompliant. Stepwise comparison of patients who were 75% or more, 50% to 74%, and less than 50% MMA compliant showed no meaningful difference in asthma outcomes between groups. CONCLUSIONS: Compliance with the HEDIS MMA measure is not related to improvement in the asthma outcomes assessed (rescue inhaler dispensing, asthma-coded hospitalizations, or asthma-coded emergency department visits).

Asthma quality-of-care markers using administrative data.

STUDY OBJECTIVE: To evaluate the relationship of potential asthma quality-of-care markers to subsequent emergency hospital care. DESIGN: Retrospective administrative database analysis. SETTING: Managed care organization. PATIENTS: Asthmatic patients aged 5 to 56 years of age. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Candidate quality measures included one or more or four or more controller medication canisters, a controller/total asthma medication ratio of > or = 0.3 or > or = 0.5, and the dispensing of fewer than six beta-agonist canisters in 2002. Outcome was a 2003 asthma emergency department visit or hospitalization. Multivariable analyses adjusted for age, sex, and year 2002 severity (based on utilization). In the total sample (n = 109,774), one or more controllers (odds ratio, 1.35) and four or more controllers (odds ratio, 1.98) were associated with an increased risk of emergency hospital care, whereas a controller/total asthma medication ratio of > or = 0.5 (odds ratio, 0.73) and the dispensing of fewer than six beta-agonist canisters (odds ratio 0.30) were associated with a decreased risk. After adjustment for baseline severity in the total asthma sample, the controller/total asthma medication ratio (odds ratio, 0.62 to 0.78) and beta-agonist measure (odds ratio, 0.42) were associated with decreased risk, whereas the dispensing of four or more canisters of controller medication was associated with increased risk (odds ratio, 1.33). After stratification by year 2002 beta-agonist use, all of the measures were associated with decreased risk in those who received fewer than six beta-agonist canisters, whereas all of the measures except the medication ratio of > or = 0.5 were associated with increased risk in the cohort who received six or more beta-agonist canisters. CONCLUSION: Controller use and beta-agonist use may function as severity indicators in large populations rather than as asthma quality-of-care markers. A medication ratio of > or = 0.5 appeared to function as the best quality-of-care marker in this study.

Asthma population management: development and validation of a practical 3-level risk stratification scheme.

OBJECTIVE: To define and validate a practical risk stratification scheme based on administrative data for use in identifying patients at high, medium, and low risk of requiring emergency hospital care for asthma. STUDY DESIGN: Retrospective cohort. PATIENTS AND METHODS: Predictors in 1999 were evaluated in relation to 2000 asthma emergency hospital care (any asthma hospitalization or emergency department visit) in a training set (n = 8789, 2000 emergency hospital care = 5.5%) and a testing set (n = 6104, 2000 emergency hospital care = 7.9%). Logistic regression was used to assign risk points in the training set, and positive and negative predictive values, sensitivities, and specificities were calculated in the training and testing sets. RESULTS: High risk was defined as asthma emergency hospital care in the previous year or use of >14 beta-agonist canisters and oral corticosteroid use; medium risk was defined as no emergency hospital care but use of either >14 beta-agonist canisters or oral corticosteroids; and low risk was defined as none of the above. For the high-risk groups in the training and testing sets, positive predictive values were 12.9% and 22.0%, sensitivities were 24.8% and 25.4%, specificities were 90.3% and 92.0%, and negative predictive values were 95.4% and 93.2%, respectively. The medium-risk groups identified another 32.6% of patients in the training set and 28.3% in the testing set requiring subsequent asthma emergency hospital care. CONCLUSION: This simple risk stratification scheme is useful for identifying patients from administrative data who are at increased risk of experiencing emergency hospital care for asthma.

Inhaled corticosteroids and allergy specialty care reduce emergency hospital use for asthma.

BACKGROUND: The interrelationships between optimal inhaled corticosteroid (IC) therapy, allergy specialist care, and reduced emergency hospital care for asthma have not been well defined. OBJECTIVE: We sought to evaluate the independent effectiveness of various levels of IC dispensing and allergy specialist care in reducing subsequent emergency asthma hospital use. METHODS: Asthmatic patients (n = 9608) aged 3 to 64 years were identified from an electronic database of a large health maintenance organization. The outcome was any year 2000 asthma hospitalization or emergency department visit. The main predictors were at least one allergy department visit and the number of IC canisters dispensed in 1999. Analyses were adjusted for age, sex, insurance type, and asthma severity (1999 emergency asthma hospital use, beta-agonist use, and oral corticosteroid use). RESULTS: Dispensing of 7 or more canisters of ICs (odds ratio [OR], 0.64; 95% CI, 0.43-0.94) and allergy care (OR, 0.73; 95% CI, 0.55-0.97) were associated with reduced subsequent emergency asthma hospital use. More patients with allergy specialist care than those without such care received 7 or more dispensations of ICs (24.7% vs 8.3%, P <.001). When 7 or more dispensations of ICs and allergy specialist care were simultaneously included in an adjusted model, both ICs (OR, 0.68; 95% CI, 0.46-1.00) and allergy care (OR, 0.77; 95% CI, 0.58-1.02) were independently associated with a lower risk of year 2000 emergency asthma hospital care, although significance was borderline. CONCLUSION: Allergy care reduces emergency hospital use for asthma by increasing use of ICs but probably also has an independent effect.