TY - JOUR
T1 - Variability in asthma quality and costs in children with different Medicaid insurance plans in Maricopa County
AU - Rank, Matthew
AU - Landman, Natalie
AU - Harootunian, Gevork
AU - Winscott, Michelle
AU - Jain, Neil
AU - Frey, Keith
AU - Wilson, Gena
AU - Drewek, Rupali
AU - Parra-Roide, Lilia
AU - Wilson, Charlton
AU - Smoldt, Robert
AU - Cortese, Denis
N1 - Publisher Copyright:
© 2018, © 2018 Taylor & Francis Group, LLC.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Objective: To describe the variation in asthma quality and costs among children with different Medicaid insurance plans. Methods: We used 2013 data from the Center for Health Information and Research, which houses a database that includes individuals who have Medicaid insurance in Arizona. We analyzed children ages 2–17 years-old who lived in Maricopa County, Arizona. Asthma medication ratio (AMR, a measure of appropriate asthma medication use), outpatient follow-up within 2 weeks after asthma-related hospitalization (a measure of continuity of care), asthma-related hospitalizations, and all emergency department (ED) visits were the primary quality metrics. Direct costs were reported in 2013 $US dollars. We used one-way analysis of variance to compare the health plans for AMR and per member cost (total, ER, and hospital), and the chi-squared test for the outpatient follow-up measure. We used coefficient of variation to identify variation of each measure across all individuals in the study. Results: In 2013, 90,652 children in Maricopa County were identified as having asthma. The average patient-weighted AMR for children with persistent asthma was 0.35, well short of the goal of ≥0.70, and only 36% of hospitalized asthma patients had outpatient follow-up within 2 weeks of hospitalization. AMR, total costs, and ED costs varied significantly (p <.0001) when comparing health plans while hospital costs and outpatient follow-up showed no significant variation. Conclusions: Targeting appropriate medication use for asthma may help reduce variation, improve outcomes, and increase healthcare value for children with asthma and Medicaid insurance in the US.
AB - Objective: To describe the variation in asthma quality and costs among children with different Medicaid insurance plans. Methods: We used 2013 data from the Center for Health Information and Research, which houses a database that includes individuals who have Medicaid insurance in Arizona. We analyzed children ages 2–17 years-old who lived in Maricopa County, Arizona. Asthma medication ratio (AMR, a measure of appropriate asthma medication use), outpatient follow-up within 2 weeks after asthma-related hospitalization (a measure of continuity of care), asthma-related hospitalizations, and all emergency department (ED) visits were the primary quality metrics. Direct costs were reported in 2013 $US dollars. We used one-way analysis of variance to compare the health plans for AMR and per member cost (total, ER, and hospital), and the chi-squared test for the outpatient follow-up measure. We used coefficient of variation to identify variation of each measure across all individuals in the study. Results: In 2013, 90,652 children in Maricopa County were identified as having asthma. The average patient-weighted AMR for children with persistent asthma was 0.35, well short of the goal of ≥0.70, and only 36% of hospitalized asthma patients had outpatient follow-up within 2 weeks of hospitalization. AMR, total costs, and ED costs varied significantly (p <.0001) when comparing health plans while hospital costs and outpatient follow-up showed no significant variation. Conclusions: Targeting appropriate medication use for asthma may help reduce variation, improve outcomes, and increase healthcare value for children with asthma and Medicaid insurance in the US.
KW - Continuity of care
KW - healthcare utilization, Medicaid insurance, medication adherence
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U2 - 10.1080/02770903.2018.1432644
DO - 10.1080/02770903.2018.1432644
M3 - Article
C2 - 29451814
AN - SCOPUS:85042215647
SN - 0277-0903
VL - 56
SP - 152
EP - 159
JO - Journal of Asthma
JF - Journal of Asthma
IS - 2
ER -