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In pediatric asthma, ratio of controller medications to total asthma medications predicts risk of exacerbations
DENVER — Although asthma exacerbations requiring hospital admissions or emergency department visits are an important outcome among children with asthma, exacerbations treated in the office setting should be more rigorously assessed, according to findings presented here at the Pediatric Academic Societies’ Annual Meeting 2011.
Furthermore, the asthma medication ratio — the ratio of controller prescriptions filled divided by all asthma prescriptions filled — is the process measure that correlates best with medically-treated asthma exacerbations (AEs), according to researchers from Children’s Hospital Boston.
Louis Vernacchio, MD, MSc, and colleagues from the Pediatric Physicians’ Organization at Children’s (PPOC), an independent practice association affiliated with Children’s Hospital Boston, set out to describe AEs among children with persistent asthma and to determine AE risk factors. According to the researchers, of 19,469 privately-insured PPOC patients aged 5 to 17 years old continuously enrolled in 2008, 530 (2.7%) met Healthcare Effectiveness Data and Information Set (HEDIS) criteria for persistent asthma. Among this cohort, the investigators first compared each of the three proposed definitions of AEs treated in the office setting to a “gold standard” chart review, which included an independent review of 144 asthma visits by two clinicians.
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The definition of AEs treated in the office setting that correlated most closely with the chart review included office visits for asthma that involved one or more of the following: 1) a filled prescription for an oral steroid on the day of or the day after the visit; 2) a nebulizer treatment given during the visit; or 3) use of an ICD-9 code indicating “with status asthmaticus” or “with acute exacerbation.” Using this definition, the 530 participants suffered 312 AEs during 2008, 237 (76.0%) of which were treated in the office setting; 67.6% of subjects had no exacerbations during the year and 32.4% had one or more.
In the second part of the study, the investigators created a logistic regression model to examine the association between various asthma process measures and AEs requiring medical attention. That analysis determined that the asthma medication ratio correlated in a linear fashion with AEs, with children in the lowest quartile of the asthma medication ratio having approximately twice the risk of AEs compared to children in the highest quartile. This result was replicated in a validation cohort from 2009.
“The asthma medication ratio is a proposed HEDIS measure for 2012, but the cutoff value for high-quality asthma care suggested by HEDIS is well below what appears optimal in our data,” Vernacchio said.
Disclosures: Dr. Vernacchio reports no relevant financial disclosures.
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