Identifying Opportunities for Improvement in Pediatric Asthma Management

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Identifying Opportunities for Improvement in
Pediatric Asthma Management
CHEAR Unit, Division of General Pediatrics,
University of Michigan

• Kevin Dombkowski, DrPH, MS
• June 25, 2005

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Background

• Asthma management is of great importance given
  high prevalence, morbidity, and mortality
• National Committee on Quality Assurance (NCQA)
  HEDIS looks at one dimension of asthma care use
  of appropriate medications
• Quality assessments are reported at the aggregate
  plan level

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Background

• National Asthma Education and Prevention Program
  (NAEPP) provides guidance on key clinical
  activities for quality asthma care
• Appropriate pharmacotherapy
• Asthma assessment and monitoring
• Control of factors contributing to asthma
  severity
• Education
• Despite longstanding availability of NAEPP
  guidelines, wide variation in adherence exists

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Background

• It is unclear whether
• a single measure accurately portrays asthma
  management for plan enrollees
• a plans aggregate quality assessments reflect
  performance throughout the areas in which it
  operates

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Objectives

• Characterize pediatric asthma care among Medicaid
  beneficiaries
• Describe how measures of health plan performance
  may vary between geographic areas
• Assess alternate measures of asthma management

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Objectives

• Two perspectives
• variation between plans, contrasting the
  performance of plans operating in similar
  geographic areas and
• variation within plans, comparing outcomes for
  enrollees within the same plan, but living in
  different geographic areas

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Methods

• Study Design Retrospective analysis of Michigan
  Medicaid administrative claims from 2002-2003
• Study Population
• 5-18 yrs. old
• continuously enrolled in Medicaid
• classified as having persistent asthma using
  HEDIS criteria in 2002 and 2003

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Methods

• Outcomes measured (2003)
• 1 asthma controller medication dispensing event
• 1 outpatient visit
• 1 asthma ED visit
• influenza vaccination
• Classified into 4 geographic regions

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Northern
Southeast
Southwest
Urban
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Methods

• Statistical analyses
• Summaries of proportions and 95 confidence
  intervals
• Rankings for each outcome by
• plan
• plan and region

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Study Population
5-18 yrs. old with persistent asthma 5,792
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Study Population
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Results
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Results
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Results
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Results
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Limitations

• Severity of asthma not based on objective
  clinical criteria
• Claims data subject to completeness and accuracy
  of reported information

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Conclusions

• Health plans may have a diverse profile of
  outcomes across a state
• Aggregate measures may not adequately describe
  plan experiences
• Multiple outcomes measures may provide a more
  comprehensive assessment of plan performance

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Implications

• Regional profiles of outcomes may reveal
  opportunities for plans to
• identify and prioritize areas in greatest need of
  asthma quality improvement initiatives
• gauge the adequacy of existing provider networks
  in local areas
• Scope of asthma performance measurement can be
  broadened using administrative claims data