Geographic variation of asthma quality measures within and between health plans

Kevin J. Dombkowski, Michael D. Cabana, Lisa M. Cohn, Achamyeleh Gebremariam, Sarah J. Clark

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: To contrast health plan performance in treating pediatric asthma within and between different geographic regions. Study Design: Retrospective analysis of administrative claims data for 18 health plans serving Medicaid enrollees. Methods: The study population was 3970 children 5-18 years old with persistent asthma who were continuously enrolled in the same Michigan Medicaid health plan for 2002 and 2003, with no other source of health insurance. Outcome measures were assessed based on national guidelines for asthma management: at least 1 asthma controller medication prescription, at least 1 outpatient visit, 1 or more asthma emergency department visits, and an annual influenza vaccination. Results: Adherence to national guidelines varied significantly (P ≤ .05) between plans. The proportion of children with at least 1 asthma controller prescription ranged from 66% to 88%; the proportion of children with influenza vaccination ranged from 3% to 46%. Plan ranking varied depending on the guideline measure used. The plan with the lowest aggregate proportion of children who had asthma controller prescriptions (66%) had regional proportions that ranged widely, from 44% to 72%. Some plans were observed to rank highly in performance in 1 region and substantially lower in other regions; similar with-plan regional variation was found for each outcome measure. Conclusions: Assessments of adherence to Medicaid pediatric asthma management guidelines at the plan level may be insufficient to identify opportunities for improvement. Administrative claims-based profiles of plan performance that are sensitive to regional variations in plan characteristics may be particularly useful in isolating and prioritizing quality-improvement opportunities.

Original languageEnglish (US)
Pages (from-to)765-772
Number of pages8
JournalAmerican Journal of Managed Care
Volume11
Issue number12
StatePublished - Dec 1 2005
Externally publishedYes

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Asthma
Health
Medicaid
Guidelines
Prescriptions
Human Influenza
Vaccination
Outcome Assessment (Health Care)
Insurance Claim Review
Pediatrics
Health Insurance
Quality Improvement
Hospital Emergency Service
Outpatients
Retrospective Studies
Population

ASJC Scopus subject areas

  • Health Policy

Cite this

Dombkowski, K. J., Cabana, M. D., Cohn, L. M., Gebremariam, A., & Clark, S. J. (2005). Geographic variation of asthma quality measures within and between health plans. American Journal of Managed Care, 11(12), 765-772.

Geographic variation of asthma quality measures within and between health plans. / Dombkowski, Kevin J.; Cabana, Michael D.; Cohn, Lisa M.; Gebremariam, Achamyeleh; Clark, Sarah J.

In: American Journal of Managed Care, Vol. 11, No. 12, 01.12.2005, p. 765-772.

Research output: Contribution to journalArticle

Dombkowski, KJ, Cabana, MD, Cohn, LM, Gebremariam, A & Clark, SJ 2005, 'Geographic variation of asthma quality measures within and between health plans', American Journal of Managed Care, vol. 11, no. 12, pp. 765-772.
Dombkowski, Kevin J. ; Cabana, Michael D. ; Cohn, Lisa M. ; Gebremariam, Achamyeleh ; Clark, Sarah J. / Geographic variation of asthma quality measures within and between health plans. In: American Journal of Managed Care. 2005 ; Vol. 11, No. 12. pp. 765-772.
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