| Process quality measures and asthma exacerbations in the medicaid population. | |
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MedLine Citation:
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PMID: 19748660 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Asthma quality assessment often focuses on controller medication use, yet claims-based studies find conflicting associations between this care process and clinical outcomes. OBJECTIVE: We sought to compare the association between 3 controller-based quality measures and asthma exacerbations to gain better understanding of how processes of care are related to clinical outcomes. METHODS: Identifying a cohort of Medicaid beneficiaries with persistent asthma by using Healthcare Effectiveness Data and Information Set (HEDIS) criteria for asthma in 2001-2002 in California and New York, we assessed 3 asthma quality metrics in 2002: (1) the current HEDIS measure of at least 1 controller medication filling; (2) at least 4 controller medication prescription fillings; and (3) a controller-to-total asthma medication ratio of at least 0.5. We calculated the odds of having an asthma exacerbation in 2003 as a function of performance on each quality metric, adjusting for race, sex, age, and prior outpatient and acute care use for asthma. RESULTS: Of 90,909 subjects with persistent asthma in California (48.1%) and New York (51.9%), those who obtained at least 1 or at least 4 controller medications had increased likelihood of poor outcomes (adjusted odds ratios, 1.80 [95% CI, 1.73-1.87] and 1.44 [95% CI 1.40-1.48], respectively). Beneficiaries meeting the controller-to-total asthma medication ratio measure were 23.0% less likely to have exacerbations (adjusted odds ratio, 0.77 [95% CI, 0.75-0.80]). CONCLUSIONS: A higher controller medication ratio indicated a lower likelihood of asthma exacerbations, whereas assessing the number of controller medication-dispensing events was associated with a higher odds of exacerbation. |
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Authors:
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Pierre L Yong; Rachel M Werner |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S. Date: 2009-09-12 |
Journal Detail:
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Title: The Journal of allergy and clinical immunology Volume: 124 ISSN: 1097-6825 ISO Abbreviation: J. Allergy Clin. Immunol. Publication Date: 2009 Nov |
Date Detail:
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Created Date: 2009-11-09 Completed Date: 2009-11-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1275002 Medline TA: J Allergy Clin Immunol Country: United States |
Other Details:
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Languages: eng Pagination: 961-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA. pyong@nas.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anti-Asthmatic Agents / therapeutic use Asthma / drug therapy*, immunology* Cohort Studies Disease Progression Female Humans Male Medicaid* Middle Aged United States |
| Grant Support | |
ID/Acronym/Agency:
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UL1-RR024134/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Anti-Asthmatic Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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