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The American Journal of Managed Care June 2018
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Identifying Children at Risk of Asthma Exacerbations: Beyond HEDIS
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Identifying Children at Risk of Asthma Exacerbations: Beyond HEDIS

Jonathan Hatoun, MD, MPH, MS; Emily K. Trudell, MPH; and Louis Vernacchio, MD, MS
Analysis of insurance claims reveals that criteria other than the Healthcare Effectiveness Data and Information Set (HEDIS) persistent asthma definition can identify more at-risk patients with reasonable loss of specificity.

Objectives: Asthma is a costly and variable disease necessitating routine population health monitoring. Insurance claims represent all paid pharmacy, diagnostic, outpatient, inpatient, and emergency care; however, current claims-based identification tools may be overly specific. We sought to determine how various definitions of asthma may improve detection of patients at risk of asthma exacerbations.

Study Design: A statistical analysis of private insurance claims for patients in a pediatric primary care network in Massachusetts.

Methods: We performed a retrospective statistical analysis for patients aged 2 to 18 years with 3 years of continuous enrollment. Multiple potential definitions were constructed and tested on 2 years of data against their ability to identify patients having an exacerbation in the third year. Definitions tested utilized patterns of medication fills and visits billed with a diagnosis of asthma, wheeze, or cough. We calculated the sensitivity and specificity of each definition and constructed a receiver operating characteristic curve.

Results: In a cohort of 28,363 patients, a definition identifying patients with 1 or more clinician visits with a diagnosis of asthma or wheeze over 2 years was most efficient in detecting patients with an exacerbation in the subsequent year (sensitivity, 0.78; specificity, 0.84). When tested on the same cohort, the Healthcare Effectiveness Data and Information Set (HEDIS) persistent asthma criteria were less sensitive but more specific (sensitivity, 0.20; specificity, 0.99).

Conclusions: Population health registries and quality measurement may benefit from using a claims-based definition of pediatric patients at risk of asthma exacerbations that is not as restrictive as the HEDIS persistent asthma criteria.

Am J Manag Care. 2018;24(6):e170-174

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