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A methodological comparison of two European primary care databases and replication in a US claims database: inhaled long-acting beta-2-agonists and the risk of acute myocardial infarction. Eur J Clin Pharmacol 2016; 72:1105-16. [PMID: 27216032 DOI: 10.1007/s00228-016-2071-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Results from observational studies on inhaled long-acting beta-2-agonists (LABA) and acute myocardial infarction (AMI) risk are conflicting, presumably due to variation in methodology. We aimed to evaluate the impact of applying a common study protocol on consistency of results in three databases. METHODS In the primary analysis, we included patients from two GP databases (Dutch-Mondriaan, UK-CPRD GOLD) with a diagnosis of asthma and/or COPD and at least one inhaled LABA or a "non-LABA inhaled bronchodilator medication" (short-acting beta-2-agonist or short-/long-acting muscarinic antagonist) prescription between 2002 and 2009. A claims database (USA-Clinformatics) was used for replication. LABA use was divided into current, recent (first 91 days following the end of a treatment episode), and past use (after more than 91 days following the end of a treatment episode). Adjusted hazard ratios (AMI-aHR) and 95 % confidence intervals (95 % CI) were estimated using time-dependent multivariable Cox regression models stratified by recorded diagnoses (asthma, COPD, or both asthma and COPD). RESULTS For asthma or COPD patients, no statistically significant AMI-aHRs (age- and sex-adjusted) were found in the primary analysis. For patients with both diagnoses, a decreased AMI-aHR was found for current vs. recent LABA use in the CPRD GOLD (0.78; 95 % CI 0.68-0.90) and in Mondriaan (0.55; 95 % CI 0.28-1.08), too. The replication study yielded similar results. Adjusting for concomitant medication use and comorbidities, in addition to age and sex, had little impact on the results. CONCLUSIONS By using a common protocol, we observed similar results in the primary analysis performed in two GP databases and in the replication study in a claims database. Regarding differences between databases, a common protocol facilitates interpreting results due to minimized methodological variations. However, results of multinational comparative observational studies might be affected by bias not fully addressed by a common protocol.
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Chang J, Freed GL, Prosser LA, Patel I, Erickson SR, Bagozzi RP, Balkrishnan R. Comparisons of health care utilization outcomes in children with asthma enrolled in private insurance plans versus medicaid. J Pediatr Health Care 2014; 28:71-9. [PMID: 23312366 DOI: 10.1016/j.pedhc.2012.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 10/30/2012] [Accepted: 11/09/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Very few studies have captured the differences in the outcomes of pediatric patients based on the patients' type of health insurance plan. The purpose of this retrospective cohort study was to examine the impact of the type of health insurance plan (public insurance vs. private insurance) on outcomes (health care utilization and medication adherence) in children with asthma. METHODS This retrospective cohort study analyzed Medicaid/commercial data from eight states licensed under Thomson Medstat. Subjects were 11,027 children with asthma (6435 enrolled in Medicaid and 4592 enrolled in a commercial health maintenance organization) who newly started asthma pharmacotherapy and were followed up for 12 months before and after the index anti-asthmatic medication fill. Data on health care utilization and medication adherence were examined to compare health care utilization-based outcomes. Quantile regression analysis was used to study medication adherence, and Poisson regression was used to determine health care utilization. RESULTS Patients with a private insurance plan had significantly higher medication adherence rates (p < .01) compared with those who had a Medicaid plan. Patients with Medicaid plans also were associated with 20% more inpatient hospitalizations and 48% increased odds of emergency department visits, but they had 42% fewer outpatient visits compared with those who had a private plan (all p < .05). CONCLUSION Children with asthma who are enrolled in Medicaid receive fairly comprehensive coverage of medical services, and thus further research is needed to determine the reasons for poor health care utilization-related outcomes in this population.
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Kawasumi Y, Abrahamowicz M, Ernst P, Tamblyn R. Development and validation of a predictive algorithm to identify adult asthmatics from medical services and pharmacy claims databases. Health Serv Res 2011; 46:939-63. [PMID: 21275988 PMCID: PMC3097410 DOI: 10.1111/j.1475-6773.2010.01235.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To develop and validate the accuracy of a predictive model to identify adult asthmatics from administrative health care databases. STUDY SETTING An existing electronic medical record project in Montreal, Quebec. STUDY DESIGN One thousand four hundred and thirty-one patients with confirmed asthma status were identified from primary care physician's electronic medical record. DATA COLLECTION/EXTRACTION METHODS Therapeutic indication of asthma in an electronic prescription and/or confirmed asthma from an automated problem list were used as the gold standard. Five groups of asthma-specific markers were identified from administrative health care databases to estimate the probability of the presence of asthma. Cross-validation evaluated the diagnostic ability of each predictive model using 50 percent of sample. PRINCIPAL FINDINGS The best performance in discriminating between the patients with asthma and those without it included indicators from medical service and prescription claims databases. The best-fitting algorithm had a sensitivity of 70 percent, a specificity of 94 percent, and positive predictive value of 65 percent. The prescriptions claims-specific algorithm demonstrated a nearly equal performance to the model with medical services and prescription claims combined. CONCLUSIONS Our algorithm using asthma-specific markers from administrative claims databases provided moderate sensitivity and high specificity.
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Affiliation(s)
- Yuko Kawasumi
- Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, Canada.
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Fifield J, McQuillan J, Martin-Peele M, Nazarov V, Apter AJ, Babor T, Burleson J, Cushman R, Hepworth J, Jackson E, Reisine S, Sheehan J, Twiggs J. Improving pediatric asthma control among minority children participating in medicaid: providing practice redesign support to deliver a chronic care model. J Asthma 2010; 47:718-27. [PMID: 20812783 DOI: 10.3109/02770903.2010.486846] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Asthma, a leading chronic disease of children, currently affects about 6.2 million (8.5%) children in the United States. Despite advances in asthma research and availability of increasingly effective therapy, many children do not receive appropriate medications to control the disease, have over-reliance on reliever medication, and lack systematic follow-up care. The situation is even worse for poor inner-city and minority children who have significantly worse asthma rates, severity, and outcomes. National Asthma Education and Prevention Program Guidelines recommend a multimodal, chronic care approach. OBJECTIVE The authors assessed the effectiveness of practice redesign and computerized provider feedback in improving both practitioner adherence to National Asthma Education and Prevention Program Guidelines (NAEPP), and patient outcomes in 295 poor minority children across four Federally Qualified Health Centers (FQHC). METHODS In a nonrandomized, two-group (intervention versus comparison), two-phase trial, all sites were provided redesign support to provide quarterly well-asthma visits using structured visit forms, community health workers for outreach and follow-up, a Web-based disease registry for tracking and scheduling, and a provider education package. Intervention sites were given an additional Web-based, computerized patient-specific provider feedback system that produced a guideline-driven medication assessment prompt. RESULTS Logistic regression results showed that providers at intervention sites were more than twice as likely on average to prescribe guideline-appropriate medications after exposure to our feedback system during the Phase I enrollment period than providers at comparison sites (exp(B) = 2.351, confidence interval [CI] = 1.315-4.204). In Phase II (the post-enrollment visit period), hierarchical linear models (HLMs) and latent growth curves were used to show that asthma control improved significantly by .19 (SE = .05) on average for each of the remaining four visits (about 11% of a standard deviation), and improved even more for patients at intervention sites. These results show that implementation of practice redesign support guided by a pediatric chronic care model can improve provider adherence to treatment guidelines as well as patients' asthma control. CONCLUSIONS The addition of patient-specific feedback for providers results in quicker adoption of guideline recommendations and potentially greater improvements in asthma control compared to the basic practice redesign support alone.
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Affiliation(s)
- Judith Fifield
- Department of Family Medicine, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030, USA.
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Koné Péfoyo AJ, Rivard M, Laurier C. [Public health surveillance and role of administrative data]. Rev Epidemiol Sante Publique 2009; 57:99-111. [PMID: 19307073 DOI: 10.1016/j.respe.2008.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 06/09/2008] [Accepted: 11/26/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Public health surveillance constitutes an important activity since it helps in identifying health needs through data collection, and contributes to decision making and actions by analyzing and interpreting data and communicating key results. METHODS This paper presents a discussion on the concept of public health surveillance, its objectives and its historical evolution. It deals with the importance of surveillance systems while describing their components and challenges. In addition, the authors point out the importance of administrative data as a relevant source for the surveillance of public health problems, particularly chronic diseases and risk factors. RESULTS This theoretical discussion leads to the proposal of a conceptual model for surveillance systems, which integrates implementation and evaluation. CONCLUSION This article provides a summary of the concept of public health surveillance and underlines the general aspects to be considered by the managers of surveillance systems. It also discusses the use of administrative data for surveillance.
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Affiliation(s)
- A J Koné Péfoyo
- Département de médecine sociale et préventive, faculté de médecine, pavillon 1420 Mont-Royal, université de Montréal, Montréal, Canada.
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Stevenson MD, Heaton PC, Moomaw CJ, Bean JA, Ruddy RM. Inhaled corticosteroid use in asthmatic children receiving Ohio Medicaid: trend analysis, 1997-2001. Ann Allergy Asthma Immunol 2008; 100:538-44. [PMID: 18592816 DOI: 10.1016/s1081-1206(10)60049-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In 1997, national guidelines emphasized that inhaled corticosteroids (ICSs) are key therapy for individuals with all classes of persistent asthma, including children. OBJECTIVE To examine the effect of these guidelines via time-trend analysis of ICS dispensation among children with asthma and Ohio Medicaid insurance. METHODS A retrospective cross-sectional analysis by yearly cohorts was performed. From January 1, 1997, to December 31, 2001, all children from birth to the age of 18 years with 6 months of Ohio Medicaid enrollment or more, 1 or more asthma diagnoses associated with a provider claim, and 1 or more prescription claims for an asthma medication in a given calendar year were identified using claims data. The daily beclomethasone equivalent (BME) dose, the daily albuterol equivalent dose, and asthma-related health care use were calculated for each child within each yearly cohort. A time-trend regression analysis of subjects enrolled in all 5 years examined factors associated with BME. RESULTS A total of 77,557 children met the study criteria. Among the 1,475 children enrolled during all 5 years, year of enrollment was a positive independent predictor of BME after adjustment for age, race, sex, systemic steroid bursts, albuterol equivalent dose, and health care use (P < .001). CONCLUSIONS The daily BME dose significantly increased for children with asthma insured by Ohio Medicaid from 1997 to 2001. However, the percentages of children receiving both ICS and a therapeutic BME dose were alarmingly low. The mean BME dose was particularly low among children with 1 or more emergency department visits, no hospitalizations, and 3 or fewer physician visits for asthma per year, suggesting that broader efforts to target this group are needed.
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Affiliation(s)
- Michelle D Stevenson
- Division of Emergency Services, Northeastern Ohio Universities College of Medicine, Akron Children's Hospital, Akron, Ohio 44308, USA.
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Wess ML, Schauer DP, Johnston JA, Moomaw CJ, Brewer DE, Cook EF, Eckman MH. Application of a decision support tool for anticoagulation in patients with non-valvular atrial fibrillation. J Gen Intern Med 2008; 23:411-7. [PMID: 18373138 PMCID: PMC2359511 DOI: 10.1007/s11606-007-0477-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Atrial fibrillation affects more than two million Americans and results in a fivefold increased rate of embolic strokes. The efficacy of adjusted dose warfarin is well documented, yet many patients are not receiving treatment consistent with guidelines. The use of a patient-specific computerized decision support tool may aid in closing the knowledge gap regarding the best treatment for a patient. METHODS This retrospective, observational cohort analysis of 6,123 Ohio Medicaid patients used a patient-specific computerized decision support tool that automated the complex risk-benefit analysis for anticoagulation. Adverse outcomes included acute stroke, major gastrointestinal bleeding, and intracranial hemorrhage. Cox proportional hazards models were developed to compare the group of patients who received warfarin treatment with those who did not receive warfarin treatment, stratified by the decision support tool's recommendation. RESULTS Our decision support tool recommended warfarin for 3,008 patients (49%); however, only 9.9% received warfarin. In patients for whom anticoagulation was recommended by the decision support tool, there was a trend towards a decreased hazard for stroke with actual warfarin treatment (hazard ratio 0.90) without significant increase in gastrointestinal hemorrhage (0.87). In contrast, in patients for whom the tool recommended no anticoagulation, receipt of warfarin was associated with statistically significant increased hazard of gastrointestinal bleeding (1.54, p = 0.03). CONCLUSIONS We have shown that our atrial fibrillation decision support tool is a useful predictor of those at risk of major bleeding for whom anticoagulation may not necessarily be beneficial. It may aid in weighing the benefits versus risks of anticoagulation treatment.
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Affiliation(s)
- Mark L Wess
- Division of General Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267-0535, USA.
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Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) are included in several national pneumococcal vaccination recommendations whereas asthma patients are not. The objective of this study was to evaluate pneumonia-related hospitalization risk in patients with COPD or asthma and vaccination impact. METHODS We identified patients with documented pneumococcal vaccination from a cohort of veterans with either a diagnosis of asthma or COPD and their matched controls. Patients were identified between October 1, 1997 and September 30, 1998 and followed for 5 years. For each group we identified pneumococcal pneumonia hospitalizations and all pneumonia-related hospitalizations in the periods before and after vaccination. We estimated hospitalization rates and compared rates in the asthma and COPD groups to controls using negative binomial regression models. RESULTS We identified 16,074 COPD patients (average age 65.8 years), 14,028 controls for the COPD patients (average age 67.5 years), 2,746 asthma patients (average age 53.0 years), and 1,345 controls for the asthma patients (average age 59.2 years). Compared to controls, the adjusted risk of pneumococcal pneumonia hospitalizations before pneumococcal vaccination was COPD = 8.02 (95% CI, 4.44-14.48) and asthma = 0.76 (0.17-3.53). For any pneumonia-related hospitalization, the adjusted risk was COPD = 3.91 (3.40-4.50) and asthma = 1.45 (0.85-2.46). After vaccination, events decreased in all groups. The adjusted risk for pneumococcal pneumonia hospitalizations postvaccination was COPD = 3.87 (2.55-5.88) and asthma = 0.30 (0.04-1.99). For any pneumonia-related hospitalization the adjusted risk was COPD = 3.71 (3.33-4.13) and asthma = 0.79 (0.50-1.25). CONCLUSIONS This study supports the value of vaccinating COPD patients; however, the value of vaccination for asthma patients is less certain.
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Affiliation(s)
- Todd A Lee
- Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, IL 60141, USA.
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Wakefield DB, Cloutier MM. Modifications to HEDIS and CSTE algorithms improve case recognition of pediatric asthma. Pediatr Pulmonol 2006; 41:962-71. [PMID: 16871628 DOI: 10.1002/ppul.20476] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Our objective was to validate the Council of State and Territorial Epidemiologists (CSTE) definition of "probable" asthma and the Health Plan Employer Data and Information Set (HEDIS) definition of persistent asthma for diagnosis of pediatric asthma, and examine modifications that improve case recognition. CSTE and HEDIS criteria were applied to a cross-sectional study of 3,905 Medicaid children with physician-confirmed diagnosis of asthma/no asthma using a validated survey instrument based upon National Asthma Education and Prevention Program (NAEPP) Guidelines. Modified criteria were applied to another group of 1,458 non-Medicaid children from a managed care organization (MCO). Of 1,852 Medicaid children with physician-confirmed asthma, 906 had persistent asthma. CSTE identified 61% of children with "probable" asthma; HEDIS identified 44% of children with persistent asthma. Correct identification increased with greater disease severity. A modified CSTE increased sensitivity from 0.61 to 0.90, while maintaining high specificity. Three new HEDIS algorithms increased sensitivity from 0.44 to >0.84, with specificity >0.89. When applied prospectively to MCO children, these new algorithms demonstrated improved sensitivity. In conclusion, studies using current CSTE or HEDIS algorithms for case recognition underestimate asthma prevalence and overestimate asthma severity in children. Modified algorithms improve the identification of "probable" and persistent asthma.
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Affiliation(s)
- Dorothy B Wakefield
- Department of Pediatrics, University of Connecticut Health Center, Hartford, Connecticut, USA.
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Knapp PK, Hurlburt MS, Kostello EC, Ladd H, Tang L, Zima BT. Child Sociodemographic Characteristics and Common Psychiatric Diagnoses in Medicaid Encounter Data: Are they Valid? J Behav Health Serv Res 2006; 33:444-52. [PMID: 17115286 DOI: 10.1007/s11414-006-9024-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study describes the rate that Medicaid encounter data on gender, race/ethnicity, and diagnosis matched information in the medical record, among a statewide sample of Medicaid children who received ongoing care for attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), and major depression (MD) in outpatient specialty mental health clinics in 1998-1999. The match rate for gender was 99%; and for race/ethnicity it was 71.8%, 90.5%, and 89.7% for Caucasian, African American, and Hispanic children, respectively. Misidentified Caucasian children were more likely to be recorded as African American or Hispanic than misidentified minority children to be recorded as Caucasian. Diagnosis match rates were high (ADHD: 98%, CD: 89%, MD: 89%). If the California Department of Mental Health relied solely on Medicaid encounter data, misclassification of African American or Hispanic children as Caucasian could produce an underestimate of their service use.
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Affiliation(s)
- Penelope K Knapp
- Department of Psychiatry, MIND Institute, University of California Davis, Sacramento, CA 95814, USA.
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Magzamen S, Mortimer KM, Davis A, Tager IB. School-based asthma surveillance: a comparison of student and parental report. Pediatr Allergy Immunol 2005; 16:669-78. [PMID: 16343089 DOI: 10.1111/j.1399-3038.2005.00304.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study addressed the comparability of data obtained from a student-based and parent-based asthma and respiratory health survey. Our goal was to ascertain whether there were meaningful and systematic differences in asthma classification based on symptom and diagnosis reports obtained separately from students and their parents. A brief, written survey, based on the International Study of Asthma and Allergy in Children questionnaire, was administered to 6th through 10th grade students in two schools in Oakland, CA, USA. Students who reported asthma-like indicators for the previous 12-month period were defined as positive and a more extensive questionnaire was mailed home to those parents. A more refined classification of asthma based on parent report of indicators was compared with student report. Forty-four percent of 1298 students were classified as positive for current asthma-like symptoms and 50% of parent surveys were returned. For the positive students with parent surveys, 59% were classified as 'probable' for asthma based on the parent survey. Overall, the agreement between parent and students' classification was 70%, and 83% for students with a parent report of physician diagnosis of asthma. Students who were discordant with parents for physician diagnosis of asthma were more likely to be male, and more likely to have a parent report of unscheduled Emergency Department visit for wheezing or trouble breathing. Findings indicated that with the exception of medication, students reported asthma indicators more frequently that parents, independent of classification. Student report of physician diagnosis with a 12-month report of an asthma symptom was determined to be a good indicator of probable current asthma. Inclusion of or reliance on a parental questionnaire is not likely to improve the reliability of a school-based asthma surveillance program in our population.
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Affiliation(s)
- Sheryl Magzamen
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA 94720-7360, USA
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Dombkowski KJ, Wasilevich EA, Lyon-Callo SK. Pediatric asthma surveillance using Medicaid claims. Public Health Rep 2005; 120:515-24. [PMID: 16224984 PMCID: PMC1497756 DOI: 10.1177/003335490512000506] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to describe the prevalence of asthma among children using alternative case definitions applied to administrative claims data, and to assess year-to-year classification concordance. METHODS This study was a retrospective cohort analysis of 357,729 children 0-18 years using 2001-2002 Michigan Medicaid claims. Asthma cases were classified using six alternative definitions based on outpatient, emergency department, inpatient, and pharmacy claims for asthma, including the Health Plan Employer Data Information Set (HEDIS) persistent asthma criteria commonly used for assessments of asthma health care quality: at least one asthma inpatient admission or emergency department visit, four or more asthma medications events, or four asthma outpatient visits and two asthma medication events. RESULTS Overall, asthma prevalence varied widely between alternative case definitions, ranging from 14.9% based on claims evidence of any type of asthma utilization to 3.7% when restricted to those with four or more asthma medication dispensing events. Among cases meeting HEDIS persistent asthma criteria in 2001, 55.5% met these criteria in 2002. Those with four or more asthma medication dispensing events had the best overall classification concordance between 2001 and 2002. Utilization of asthma services and prevalence estimates were highest among children younger than 5 years old, but year-to-year classification concordance was poorest among these cases (p < 0.0001), irrespective of case definition. CONCLUSIONS While overall asthma prevalence may remain relatively stable from year to year, individuals may not be classified consistently as cases over time, regardless of case definition. Studies that identify asthma cases in one year and assess asthma outcomes in a subsequent year may introduce substantial bias as a result of case misclassification. Among the case definitions considered in this study, our findings suggest that this bias is minimized among cases classified using the four or more asthma medication dispensing events criterion.
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Affiliation(s)
- Kevin J Dombkowski
- Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI 48109-0456, USA.
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Twiggs JE, Fifield J, Jackson E, Cushman R, Apter A. Treating asthma by the guidelines: developing a medication management information system for use in primary care. ACTA ACUST UNITED AC 2005; 7:244-60. [PMID: 15669584 DOI: 10.1089/dis.2004.7.244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to develop, implement, and assess an automated asthma medication management information system (MMIS) that provides patient-specific evaluative guidance based on 1997 NAEPP clinical consensus guidelines. MMIS was developed and implemented in primary care settings within a pediatric asthma disease management program. MMIS infrastructure featured a centralized database with Internet access. MMIS collects detailed patient asthma medication data, evaluates pharmacotherapy relative to practitioner-reported disease severity, symptom control and model of guideline-recommended severity-appropriate medications and produces a patient-specific "curbside consult" feedback report. A system algorithm translates actual detailed medication data into actual severity-specific medication-class combinations. A table-driven computer program compares actual medication-class combinations to a guideline-based medication-class combinations model. Methodology determines whether the patient was prescribed a "severity-appropriate" amount or an amount "more" or "less" medication than indicated for patient's reported severity. Feedback messages comment on comparison. Missing data, unrecognized amounts of controller medication or unrecognized medication combinations create error cases. Post hoc review analyzed error cases to determine prevalence of non-guideline medicating practices among these practitioners. Proportion of valid and error cases across two clinical visits before and after post hoc clinical review were measured, as well as proportion of severity-appropriate, out-of-severity and non-guideline medications. MMIS produced a valid feedback report for 83% of patient visits. Missing data accounted for 60% of error cases. Practitioners used severity-appropriate medications for 60% of cases. When non-severity-appropriate medications were used they tended to be "too much" rather than "too little" (22%, 5%), suggesting appropriate use of guideline-recommended "step down" therapy by these practitioners.
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Affiliation(s)
- Joan E Twiggs
- Department of Sociology, Anthropology and Social Work, Kansas State University, Manhattan, Kansas, USA.
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