Asthma Quality-of-Care Markers Using Administrative Data* Michael Schatz, MD, MS, FCCP; Randy Nakahiro, PharmD; William Crawford, MD; Guillermo Mendoza, MD; David Mosen, MPH, PhD; and Thomas B. Stibolt, MD, FCCP Study objective: To evaluate the relationship of potential asthma quality-of-care markers to subsequent emergency hospital care. Design: Retrospective administrative database analysis. Setting: Managed care organization. Patients: Asthmatic patients aged 5 to 56 years of age. Interventions: None. Measurements and results: Candidate quality measures included one or more or four or more controller medication canisters, a controller/total asthma medication ratio of > 0.3 or > 0.5, and the dispensing of fewer than six -agonist canisters in 2002. Outcome was a 2003 asthma emergency department visit or hospitalization. Multivariable analyses adjusted for age, sex, and year 2002 severity (based on utilization). In the total sample (n  109,774), one or more controllers (odds ratio, 1.35) and four or more controllers (odds ratio, 1.98) were associated with an increased risk of emergency hospital care, whereas a controller/total asthma medication ratio of > 0.5 (odds ratio, 0.73) and the dispensing of fewer than six -agonist canisters (odds ratio 0.30) were associated with a decreased risk. After adjustment for baseline severity in the total asthma sample, the controller/total asthma medication ratio (odds ratio, 0.62 to 0.78) and -agonist measure (odds ratio, 0.42) were associated with decreased risk, whereas the dispensing of four or more canisters of controller medication was associated with increased risk (odds ratio, 1.33). After stratification by year 2002 -agonist use, all of the measures were associated with decreased risk in those who received fewer than six -agonist canisters, whereas all of the measures except the medication ratio of > 0.5 were associated with increased risk in the cohort who received six or more -agonist canisters. Conclusion: Controller use and -agonist use may function as severity indicators in large populations rather than as asthma quality-of-care markers. A medication ratio of > 0.5 appeared to function as the best quality-of-care marker in this study. (CHEST 2005; 128:1968 –1973) Key words: asthma emergency department visits; asthma hospitalizations; asthma medication; asthma quality measures; population management Abbreviations: ED = emergency department; HEDIS = Health Employer Data and Information Set A sthma is an extremely common chronic illness that imposes a large human and economic cost on our society. 1,2 Since 1991, national asthma treat- ment guidelines have been promulgated in this country, 3 setting the expectation that asthma can usually be controlled. However, despite these guide- lines, the available data suggest that asthma remains inadequately controlled in most patients. 4–6 Managed care organizations and others have at- tempted to improve asthma outcomes through the use of asthma quality-of-care or performance mea- sures. The most widely used asthma quality-of-care measure is the one developed by the National Com- mittee for Quality Assurance to evaluate the perfor- mance of health plans, the Health Employer Data and Information Set (HEDIS) measure. 7 This mea- sure identifies patients with “persistent asthma” based on administrative data criteria and then eval- uates the proportion of these patients who receive at least one canister of a controller medication the following year. However, one recent study 8 has shown that patients from the HEDIS persistent *From the Department of Allergy (Drs. Schatz, Crawford, and Mendoza), Pharmacy Analytical Services (Dr. Nakahiro), and Care Management Institute (Drs. Mosen and Stibolt), Kaiser- Permanente Medical Center, San Diego, Los Angeles, and Oakland, CA. Manuscript received January 6, 2005; revision accepted February 25, 2005. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal. org/misc/reprints.shtml). Correspondence to: Michael Schatz, MD, MS, FCCP, Depart- ment of Allergy, Kaiser-Permanente Medical Center, 7060 Claire- mont Mesa Blvd, San Diego, CA 92111; e-mail: michael.x.schatz@ kp.org 1968 Clinical Investigations Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/22032/ on 06/27/2017