Currently Viewing:
The American Journal of Managed Care April 2017
Physician Variation in Lung Cancer Treatment at the End of Life
Jonas B. Green, MD, MPH, MSHS; Martin F. Shapiro, MD, PhD; Susan L. Ettner, PhD; Jennifer Malin, MD, PhD; Alfonso Ang, PhD; and Mitchell D. Wong, MD, PhD
Real-World Evidence and the Behavioral Economics of Physician Prescribing
Bruce Feinberg, DO
Provider Type and Management of Common Visits in Primary Care
Douglas W. Roblin, PhD; Hangsheng Liu, PhD; Lee F. Cromwell, MS; Michael Robbins, PhD; Brandi E. Robinson, MPH; David Auerbach, PhD; and Ateev Mehrotra, MD, MPH
Concentration of High-Cost Patients in Hospitals and Markets
Nancy D. Beaulieu, PhD; Karen E. Joynt, MD, MPH; Robert Wild, MS, MPH; and Ashish K. Jha, MD, MPH
The Relationship Between Adherence and Total Spending Among Medicare Beneficiaries With Type 2 Diabetes
Joanna P. MacEwan, PhD; John J. Sheehan, PhD; Wes Yin, PhD; Jacqueline Vanderpuye-Orgle, PhD; Jeffrey Sullivan, MS; Desi Peneva, MS; Iftekhar Kalsekar, PhD; and Anne L. Peters, MD
Can Primary Care Physicians Accurately Predict the Likelihood of Hospitalization in Their Patients?
Andrew S. Hwang, MD, MPH; Jeffrey M. Ashburner, PhD, MPH; Clemens S. Hong, MD, MPH; Wei He, MS; and Steven J. Atlas, MD, MPH
Currently Reading
The Breathmobile Improves the Asthma Medication Ratio and Decreases Emergency Department Utilization
Tricia Morphew, MSc; Wendy Altamirano, MPH, MBA; Stanley L. Bassin, EdD; and Stanley P. Galant, MD
Medication Burden in Patients With Acute Coronary Syndromes
Eric A. Wright, PharmD, MPH; Steven R. Steinhubl, MD; J.B. Jones, PhD, MBA; Pinky Barua, MSc, MBA; Xiaowei Yan, PhD; Ryan Van Loan, BA; Glenda Frederick, BA; Durgesh Bhandary, MS; and David Cobden, Ph
Battling the Chargemaster: A Simple Remedy to Balance Billing for Unavoidable Out-of-Network Care
Barak D. Richman, JD, PhD; Nick Kitzman, JD; Arnold Milstein, MD, MPH; and Kevin A. Schulman, MD

The Breathmobile Improves the Asthma Medication Ratio and Decreases Emergency Department Utilization

Tricia Morphew, MSc; Wendy Altamirano, MPH, MBA; Stanley L. Bassin, EdD; and Stanley P. Galant, MD
An examination of the asthma medication ratio (≥0.50) as an informative metric in program evaluation and for healthcare organizations to measure quality of care provided to patients with asthma.
We have demonstrated that the AMR is a useful quality-of-care metric because it is significantly related to improved asthma outcomes. In our study, those with an AMR ≥.50 had 49% fewer ED visits compared with those with an AMR <.50 (P <.05) in 164 high-risk Medicaid-insured Hispanic children. Our data suggest that the BM model of care was superior to UC by increasing the percent of patients who achieved an AMR ≥0.50 from a baseline of 47.2% to 80.6% versus 50.0% to 65.2% post year, respectively. This was associated with a reduction of 52% in ED visits in the BM program (P <.05) compared with 13% in the UC cohort (P ≥.05). Although the AMR has been applied to assess large healthcare organizations, we have shown in a smaller cohort that it is an effective metric on quality of asthma care. Our findings should lead others to view achievement of the AMR ≥0.50 as an informative metric in program evaluation and for healthcare organizations to measure the quality of care provided to patients with asthma.

Acknowledgments

The authors thank Cristina Bernal for her assistance with manuscript preparation.

Author Affiliations: Morphew Consulting, LLC (TM), Bothell, WA; Children’s Hospital of Orange County (WA, SPG), Orange, CA; University of California, Irvine (SLB, SPG), Irvine, CA.

Source of Funding: CalOptima.

Author Disclosures: Ms Morphew has a consulting agreement with Children’s Hospital of Orange County, which funded the analysis. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (TM, WA, SLB, SPG); acquisition of data (TM, WA, SLB, SPG); analysis and interpretation of data (TM, WA, SPG); drafting of the manuscript (TM, WA, SLB, SPG); critical revision of the manuscript for important intellectual content (TM, WA, SLB, SPG); statistical analysis (TM); provision of patients or study materials (WA, SPG); obtaining funding (WA, SPG); administrative, technical, or logistic support (SPG); and supervision (WA, SPG).

Address Correspondence to: Tricia Morphew, MSc, Morphew Consulting, LLC, 2208 242nd St SW, Bothell, WA 98021. E-mail: tricia@morphewconsulting.com. 
REFERENCES

1. Bloom B, Jones LI, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2012. Vital Health Stat 10. 2013;(258):1-81.

2. Asthma & children fact sheet. American Lung Association website. http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/learn-about-asthma/asthma-children-facts-sheet.html. Published September 2014. Accessed September 29, 2015.

3. Trends in asthma morbidity and mortality. American Lung Association website. http://www.lung.org/assets/documents/research/asthma-trend-report.pdf. Published September 2012. Accessed September 29, 2015.

4. Corso P, Fertig A. The long-term economic costs of asthma. Partnership for America’s Ecomomic Success website. http://readynation.s3.amazonaws.com/wp-content/uploads/The-Long-term-Economic-Costs-of-Asthma.pdf. Published September 2008. Accessed September 29, 2015.

5. Meng YY, Babey SH, Wolstein J. Asthma-related school absenteeism and school concentration of low-income students in California. Prev Chronic Dis. 2012;9:E98.

6. Wang LY, Zhong Y, Wheeler L. Direct and indirect costs of asthma in school-age children. Prev Chronic Dis. 2005;2(1):A11.

7. Akinbami LJ, Moorman JE, Bailey C, et al. Trends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. NCHS Data Brief. 2012;(94):1-8.

8. Oraka E, Iqbal S, Flanders WD, Brinker K, Garbe P. Racial and ethnic disparities in current asthma and emergency department visits: findings from the National Health Interview Survey, 2001-2010. J Asthma. 2013;50(5):488-496. doi: 10.3109/02770903.2013.790417.

9. Malhotra K, Baltrus P, Zhang S, McRoy L, Immergluck LC, Rust G. Geographic and racial variation in asthma prevalence and emergency department use among Medicaid-enrolled children in 14 southern states. J Asthma. 2014;51(9):913-921. doi: 10.3109/02770903.2014.930479.

10. Akinbami LJ, Moorman JE, Simon AE, Schoendorf KC. Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001-2010. J Allergy Clin Immunol. 2014;134(3):547-553.e5. doi: 10.1016/j.jaci.2014.05.037.

11. Nath JB, Hsia RY. Children’s emergency department use for asthma, 2001-2010. Acad Pediatr. 2015;15(2):225-230. doi: 10.1016/j.acap.2014.10.011.

12. Gergen PJ, Togias A. Inner city asthma. Immunol Allergy Clin North Am. 2015;35(1):101-114. doi: 10.1016/j.iac.2014.09.006.

13. Forno E, Celedón JC. Predicting asthma exacerbations in children. Curr Opin Pulm Med. 2012;18(1):63-69. doi: 10.1097/MCP.0b013e32834db288.

14. Yong PL, Werner RM. Process quality measures and asthma exacerbations in the Medicaid population. J Allergy Clin Immunol. 2009;124(5):961-966. doi: 10.1016/j.jaci.2009.07.027.

15. Schatz M, Zeiger RS, Yang SJ, et al. Relationship of asthma control to asthma exacerbations using surrogate markers within a managed care database. Am J Manag Care. 2010;16(5):327-333.

16. Rust G, Zhang S, Reynolds J. Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma. J Asthma. 2013;50(7):769-775. doi: 10.3109/02770903.2013.799687.

17. HEDIS 2015 measures. National Committee for Quality Assurance website. http://www.ncqa.org/Portals/0/HEDISQM/Hedis2015/List_of_HEDIS_2015_Measures.pdf. Accessed September 29, 2015.

18. Crans Yoon A, Crawford W, Sheikh J, Nakahiro R, Gong A, Schatz M. The HEDIS medication management for people with asthma measure is not related to improved asthma outcomes. J Allergy Clin Immunol Pract. 2015;3(4):547-552. doi: 10.1016/j.jaip.2015.02.002.

19. Berger WE, Legoretta AP, Blaiss MS, et al. The utility of the Health Plan Employer Data and Information Set (HEDIS) asthma measure to predict asthma-related outcomes. Ann Allergy Asthma Immunol. 2004;93(6):538-545.

20. Schatz M, Stempel D, American College of Allergy, Asthma and Immunology Task Force; American Academy of Allergy, Asthma and Immunology Task Force. Asthma quality-of-care measures using administrative data: relationships to subsequent exacerbations in multiple databases. Ann Allergy Asthma Immunol. 2008;101(3):235-239.

21. Schatz M, Zeiger RS, Vollmer WM, et al. The controller-to-total asthma medication ratio is associated with patient-centered as well as utilization outcomes. Chest. 2006;130(1):43-50.

22. Vernacchio L, Trudell EK, Muto JM. Correlation of care process measures with childhood asthma exacerbations. Pediatrics. 2013;131(1):e136-e143. doi: 10.1542/peds.2012-1144.

23. Beck AF, Bradley CL, Huang B, Simmons JM, Heaton PC, Kahn RS. The pharmacy-level asthma medication ratio and population health. Pediatrics. 2014;135(6):1009-1017. doi: 10.1542/peds.2014-3796.

24. Stanford RH, Shah MB, D’Souza AO, Schatz M. Predicting asthma outcomes in commercially insured and Medicaid populations? Am J Manag Care. 2013;19(1):60-67.

25. Jones CA, Clement LT, Hanley-Lopez J, et al. The Breathmobile™ Program: structure, implementation, and evolution of a large-scale, urban, pediatric asthma disease management program. Dis Manag. 2005;8(4):205-222.

26. Liao O, Morphew T, Amarao S, Galant SP. The Breathmobile: a novel comprehensive school-based mobile asthma care clinic for urban underprivileged children. J Sch Health. 2006;76(6):313-319.

27. Scott L, Morphew T, Bollinger ME, et al. Achieving and maintaining asthma control in inner-city children. J Allergy Clin Immunol. 2011;128(1):56-63. doi: 10.1016/j.jaci.2011.03.020.

28. Morphew T, Scott L, Li M, et al. Mobile healthcare operations and return on investment in predominately underserved children with asthma: the Breathmobile program. Popul Health Manag. 2013;16(4):261-269. doi: 10.1089/pop.2012.0060.

29. Schatz M, Zeiger RS, Yang SJ, et al. Persistent asthma defined using HEDIS versus survey criteria. Am J Manag Care. 2010;16(11):e281-e288.

30. Schatz M, Zeiger RS, Yang SJ, et al. Relationship of asthma control to asthma exacerbations using surrogate markers within a managed care database. Am J Manag Care. 2010;16(5):327-333.

31. Rust G, Zhang S, Reynolds J. Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma. J Asthma. 2013;50(7):769-775. doi: 10.3109/02770903.2013.799687.

32. Rust G, Zhang S, McRoy L, Pisu M. Potential savings from increasing adherence to inhaled corticosteroid therapy in Medicaid-enrolled children. Am J Manag Care. 2015;21(3):173-180.

33. Bollinger ME, Morphew T, Mullins CD. The Breathmobile program: a good investment for underserved children with asthma. Ann Allergy Asthma Immunol. 2010;105(4):274-281. doi: 10.1016/j.anai.2010.07.012.

34. Bax K, Shedda S, Frizelle F. The New Zealand mobile surgical bus service: what is it achieving? N Z Med J. 2006;119(1236):U2025.

35. Krol DM, Redlener M, Shapiro A, Wajnberg A. A mobile medical care approach targeting underserved populations in post-Hurricane Katrina Mississippi. J Health Care Poor Underserved. 2007;18(2):331-340.  
PDF
 
Copyright AJMC 2006-2017 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up
×

Sign In

Not a member? Sign up now!