Asthma Quality-of-Care Markers Using Administrative Data

Schatz, Michael; Nakahiro, Randy; Crawford, William W.; Mendoza, Guillermo; Mosen, David M.; Stibolt, Thomas B.

doi:10.1378/chest.128.4.1968

Cited by 96 publications

(74 citation statements)

References 16 publications

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“…Existing provider-and patient-level measures could be translated for use by pharmacies to gauge community-level adherence to evidence-based asthma care. [19][20][21] Moreover, tracking medication fills could highlight ways in which pharmacies could deliver proactive, as opposed to reactive, asthma care. 22,23 New or redesigned processes could benefit from novel performance measures that illustrate the quality of care that reaches patients.…”

Section: What This Study Adds: a Newly Developedmentioning

confidence: 99%

“…This cut point was chosen given previous evidence at the patient level demonstrating that an AMR ,0.5 is associated with increased utilization (eg, ED visitation or hospitalization) and lower quality of life. 19,21,29,30 Second, we explored a potential dose effect using quintiles, placing each pharmacy into 1 of 5 groups based on ascending Ph-AMR. Finally, Ph-AMR was treated as a continuous variable.…”

Section: Calculation Of the Ph-amrmentioning

confidence: 99%

“…The AMR is currently used by physicians and managed care organizations to improve adherence to evidence-based guidelines and has shown consistent associations with symptom control. [19][20][21]24,30 Guided by the AMR and motivated by deep disparities across our community, 4 we developed the Ph-AMR as a means of harnessing geographic variation to inform allocation of resources to those pharmacies and areas in most need of improvement. 33,34 The Ph-AMR could identify pharmacies that are underdispensing controller medications while also facilitating a deeper understanding among pharmacies of their population in ways that would prompt the design of innovative interventions.…”

Section: Figurementioning

confidence: 99%

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The Pharmacy-Level Asthma Medication Ratio and Population Health

et al. 2015

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Section: What This Study Adds: a Newly Developedmentioning

confidence: 99%

Section: Calculation Of the Ph-amrmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

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The Pharmacy-Level Asthma Medication Ratio and Population Health

et al. 2015

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“…Using comprehensive pharmacy dispensing records, we computed continuous medication acquisition (CMA) indices (6)(7)(8) to measure fill/refill adherence for controller medications (inhaled corticosteroids, leukotriene modifiers, and others) and for long-acting b agonists (LABA) during the 12 months before and after randomization of individual participants. Controller and LABA medication regimen strength was measured by cumulative beclomethasone canister-equivalents (C-E) and salmeterol diskus-equivalents (D-E), respectively, using a standardized weighting methodology (9). Clinical outcome measures included the symptom subscale of the Juniper mini-Asthma Quality of Life Questionnaire (mini-AQLQ) (10), the Asthma Therapy Assessment Questionnaire (ATAQ) (11), asthma-related health care utilization, rescue medication use (via albuterol C-E), and lung function.…”

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confidence: 99%

Influence of Body Mass Index on Effects of a Shared Asthma Treatment Decision-Making Intervention

Ayala¹,

Wilson²,

Ma³

et al. 2012

Am J Respir Crit Care Med

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Endobronchial metastasis is defined as nonpulmonary neoplasms that metastasize to the proximal central or subsegmental bronchus, in a bronchoscopically visible range, and is frequently associated with primary tumors of the kidney, colon/rectum, breast, and others (2). To the best of our knowledge, there have been no previous reports of endobronchial metastasis from gastrinoma. This is the first reported case of endobronchial metastasis from gastrinoma. Therefore, the present case reminds physicians to consider endobronchial metastasis from extrathoracic endocrine neoplasms.Therapy for gastrinoma includes surgery for localized disease, debulking surgery for metastatic disease, and chemotherapy. More than sixty percent of gastrinomas are malignant; 5-year survival for patients with gastrinoma with liver metastases is between 40% and 75%, and it is almost 100% when no liver metastases are present (3). In this patient, tumor progression has been slow, and he remains almost asymptomatic after debulking surgery for liver metastases and chemotherapy. 2007-2008 (2). A meta-analysis of prospective studies showed a dose-dependent relationship between increasing body mass index (BMI) and the risk of incident asthma (3). Understanding the influence of BMI and obesity on effectiveness of interventions to improve asthma control will help clinicians better care for obese patients with asthma. The Better Outcomes of Asthma Treatment study, a randomized controlled trial in 612 adults with poorly controlled asthma, found that a shared treatment decision-making (SDM) intervention improved controller medication adherence and clinical outcomes (4). Given the increased attention to the links between obesity and asthma, we conducted post hoc analyses to investigate whether baseline BMI modified the SDM intervention effects on asthma medication acquisition outcomes (fill/ refill adherence and regimen strength) and clinical outcomes in the follow-up year. We hypothesized that obese patients would have benefitted less from the SDM intervention than did overweight or normal weight patients. Some of the results reported here were previously reported in the form of an abstract (5).Standard BMI categories were defined: normal (18.5-24.9 kg/m 2 , n ¼ 132) and underweight (,18.5 kg/m 2 , n ¼ 7) combined, overweight (25-29.9 kg/m 2 , n ¼ 185), and obese ($30 kg/m 2 , n ¼ 286). Using comprehensive pharmacy dispensing records, we computed continuous medication acquisition (CMA) indices (6-8) to measure fill/refill adherence for controller medications (inhaled corticosteroids, leukotriene modifiers, and others) and for long-acting b agonists (LABA) during the 12 months before and after randomization of individual participants. Controller and LABA medication regimen strength was measured by cumulative beclomethasone canister-equivalents (C-E) and salmeterol diskus-equivalents (D-E), respectively, using a standardized weighting methodology (9). Clinical outcome measures included the symptom subscale of the Juniper mini-Asthma Quality of Life Questi...

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“…27 We included a severity marker based on short-acting beta agonist (SABA) pharmacy claims, a method that has been used in previously published studies. 28 Patients' conditions were labeled as severe if they had six or more pharmacy claims for SABAs in the calendar year of the hospitalization. …”

mentioning

confidence: 99%

Under-Utilization of Controller Medications and Poor Follow-Up Rates Among Hospitalized Asthma Patients

Lintzenich

Teufel

Basco

2011

Hospital Pediatrics

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OBJECTIVE: Recommended preventive care following an asthma admission includes prescribing controller medications and encouraging outpatient follow-up. We sought to determine (1) the proportion of patients who receive controller medications or attend follow-up after asthma admission and (2) what factors predict these outcomes. METHODS: South Carolina Medicaid data from 2007-2009 were analyzed.Patients who were included were 2 to 18 years old, and had at least one admission for asthma. Variables examined were: age, gender, race, and rural location. Outcome variables were controller medication prescription and follow-up appointment. Any claim for an inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist in the 2 months after admission was considered appropriate. Any outpatient visit for asthma in the 2 months after admission was considered appropriate. Bivariate analyses used chi-square tests. Logistic regression models identifi ed factors that predict controller medications and follow-up. RESULTS:Five hundred fi ve patients were included, of whom 60% were male, 79% minority race/ethnicity, and 58% urban. Rates of receiving controller medications and attending follow-up appointments were low, and an even lower proportion received both. Overall, 52% received a controller medication, 49% attended follow-up, and 32% had both. Multivariable analyses demonstrated that patients not of minority race or ethnicity were more likely to receive controller medications (odds ratio, 1.7; 95% confi dence interval, 1.1-2.6). CONCLUSIONS:Patients with asthma admitted for acute exacerbations in South Carolina have low rates of controller medication initiation and followup attendance. Minority race/ethnicity patients are less likely to receive controller medications. To decrease rates of future exacerbations, inpatient providers must improve the rates of preventive care delivery in the acute care setting with a focus on racial/ethnic minority populations. IntroductionAsthma is the most prevalent chronic condition affecting children.1,2 The prevalence of asthma continues to increase. 1,3 In addition, morbidity and mortality associated with asthma continues to increase, including the number of hospitalizations, missed school days, and missed parental work days. 1,4 Asthma is one of the most common reasons for hospital admission among children.1,5 Appropriate use of controller medications can reduce asthma exacerbations, acute care visits for asthma, and hospitalizations. 5,7 Acknowledging the high rates of acute care visits for asthma, the Institute of Medicine has identifi ed asthma as an ambulatory care-sensitive condition. AN OFFICIAL JOURNAL OF THE AMERICAN ACADEMY OF PEDIATRICSDespite this, current evidence suggests that pediatric asthma patients underutilize preventive care in the ambulatory setting, including controller medications. [9][10][11][12] Asthma patients who are admitted to the hospital for acute exacerbations are at higher risk for future exacerbations 13,14 ; therefore, it is paramount that these patie...

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Asthma Quality-of-Care Markers Using Administrative Data

Cited by 96 publications

References 16 publications

The Pharmacy-Level Asthma Medication Ratio and Population Health

The Pharmacy-Level Asthma Medication Ratio and Population Health

Influence of Body Mass Index on Effects of a Shared Asthma Treatment Decision-Making Intervention

Under-Utilization of Controller Medications and Poor Follow-Up Rates Among Hospitalized Asthma Patients

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