An assessment of the predictive value of low risk criteria for children with intermittent asthma.

BACKGROUND: Current asthma guidelines recommend short acting beta agonist medication (SABA) be used in combination with an inhaled corticosteroid to reduce risk for severe asthma exacerbations. This may not be appropriate for patients at low risk for severe exacerbations. METHODS: This study is a cohort study using computerized claims data from Texas Children's Health Plan. Inclusion criteria were members 1 to <18 years with a diagnosis of asthma in a baseline year between 2016 and 2018 and who had ≤2 SABA canisters or equivalent dispensed, no oral corticosteroid or inhaled corticosteroid dispensing, no asthma hospitalizations, and no asthma emergency department visits in the baseline year. Follow up year outcomes of asthma hospitalizations and emergency department visits were determined for the year following the baseline year. FINDINGS: Forty-five thousand two hundred and thiry health plan members 1 to <18 years met inclusion criteria. The rate of follow up year asthma hospitalization was 1.1 per thousand for those with no baseline SABA dispensing and 1.5 per thousand for those with >0 and ≤2 SABA canister dispensings (p = 0.3). Follow up year Emergency Department visits rates were 14 per thousand and 17 per thousand, respectively (p = 0.08). In analyses adjusted for age group, the follow up year asthma hospitalization rate was not different comparing the 0 SABA to the >0 and ≤2 SABA canister dispensings group (odds ratio: 0.99, 95% confidence interval: 0.54-1.81). INTERPRETATION: Asthma patients at low risk for severe exacerbations can be identified. This information can be useful to guide treatment decisions.

Evaluation of a pediatric asthma high-risk scoring algorithm.

OBJECTIVES: Identification of patients with asthma at increased risk for hospitalization and emergency department (ED) visits presents opportunity for intervention. STUDY DESIGN: Retrospective analysis of computerized health plan claims data. METHODS: Texas Children's Health Plan, a large Medicaid managed care program, developed an asthma risk scoring algorithm using the clinically relevant parameters of hospitalization for asthma, ED visits for asthma, short-acting ß agonist medication dispensing, inhaled corticosteroid medication dispensing, number of prescribing providers, loss to follow-up, and oral corticosteroid dispensing. The risk score performance was evaluated using 2016-2018 risk scores to predict 2017-2019 asthma hospitalizations and ED visits. RESULTS: We identified 107,811 unique members aged 1 to less than 18 years with an asthma diagnosis. For those aged 3 to less than 18 years, the area under the receiver operating characteristic curve (AUC) for risk score predicting hospitalization ranged from 0.72 to 0.79. For those aged 1 to less than 3 years, the AUC ranged from 0.65 to 0.69. Those with a risk score of 1 or greater accounted for 20% to 23% of pediatric members 3 to less than 18 years with asthma but 53% to 56% of asthma hospitalizations in the follow-up year. Sixteen to eighteen percent of those aged 3 to less than 18 years with a risk score of 9 or greater were hospitalized in the follow-up year. CONCLUSIONS: Texas Children's Health Plan asthma risk score stratifies risk of asthma hospitalization and ED visits for Medicaid-insured children. The risk score performs better for children aged 3 to less than 18 years than for those aged 1 to less than 3 years.

Oral Corticosteroid Prescribing for Children With Asthma in a Medicaid Managed Care Program.

BACKGROUND AND OBJECTIVE: Short courses of oral corticosteroid (OCS) medication are recommended for treatment of moderate to severe asthma exacerbations. Concern has been raised about OCS overuse. Our objective is to describe rates of OCS dispensing among children with asthma and factors associated with variation in OCS dispensing. METHODS: Claims data for children 1 to <18 years of age with an asthma diagnosis between January 2011 and January 2016 were extracted from the computerized databases of Texas Children's Health Plan. RESULTS: In the years 2011 to 2015, 17.1% to 21.8% of children had an asthma diagnosis. In each of these years 42.1% to 44.2% of these children had ≥1 OCS dispensing. OCS dispensing rates were higher for the children 1 to 4 years of age compared with older children. Repeated OCS dispensing was common, and was most common for children 1 to 4 years of age. Most children with an OCS dispensing (81%-83%) did not have other utilization suggesting poor asthma control (excessive ß-agonist refills, emergency department visit, or hospitalization for asthma). OCSs were less commonly prescribed to patients whose primary care provider was a board-certified pediatrician compared with other types of primary care providers. There was large variation in OCS prescribing rates among pediatricians (15%-86%). There were minimal differences in asthma emergency department visits and no differences in hospitalization rates by the pediatrician's OCS dispensing rate quartile. CONCLUSIONS: The patterns of dispensing observed suggest substantial overprescribing of OCS for children with an asthma diagnosis.

The Impact of Tobacco Smoke Exposure on Childhood Asthma in a Medicaid Managed Care Plan.

BACKGROUND: Tobacco smoke exposure increases breathing problems of children. Texas Children's Health Plan is a Managed Medicaid and Children's Health Insurance Program (CHIP) managed care provider. The aim of this study is to determine associations among tobacco smoke exposure, asthma prevalence, and asthma health-care utilization. METHODS: Texas Children's Health Plan conducts an annual survey of members who have a physician visit. Questions were added to the survey in March 2010 about asthma and tobacco smoke exposure. Survey results for children < 18 years of age were matched to health plan claims data for the 12 months following the date of the physician visit. RESULTS: A total of 22,470 parents of unique members/patients from birth to < 18 years of age participated in the survey. More whites than African Americans or Hispanics report that the child's mother is a smoker (19.5% vs 9.1% and vs 2.3%, respectively; P < .001). Compared with children whose mother does not smoke, parent report of asthma diagnosis and claims for dispensing of short-acting beta agonist medication are greater if the mother is a smoker (adjusted OR, 1.20 [95% CI, 1.03-1.40] and 1.24 [95% CI, 1.08-1.42], respectively). In contrast to Medicaid, in which there are no out-of-pocket costs, the CHIP line of business requires copays for ED visits. ED visits are influenced by maternal smoking only in the CHIP line of business (adjusted OR, 4.40; 95% CI, 1.69-11.44). CONCLUSION: Maternal smoking increases risk for asthma diagnosis and prescription of asthma quick relief medication. Maternal smoking predicted asthma-related ED visits only for the CHIP line of business.