Yong Pierre L, Werner Rachel M
Department of Medicine, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
J Allergy Clin Immunol. 2009 Nov;124(5):961-6. doi: 10.1016/j.jaci.2009.07.027. Epub 2009 Sep 12.
Asthma quality assessment often focuses on controller medication use, yet claims-based studies find conflicting associations between this care process and clinical outcomes.
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.
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.
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]).
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.
哮喘质量评估通常侧重于控制药物的使用，但基于索赔的研究发现这一护理过程与临床结果之间的关联相互矛盾。
我们试图比较3种基于控制药物的质量指标与哮喘急性发作之间的关联，以更好地理解护理过程与临床结果之间的关系。
通过使用2001 - 2002年加利福尼亚州和纽约州哮喘的医疗保健有效性数据和信息集（HEDIS）标准，确定一组患有持续性哮喘的医疗补助受益人群，我们在2002年评估了3项哮喘质量指标：（1）当前HEDIS指标中至少有1次控制药物配药；（2）至少4次控制药物处方配药；（3）控制药物与哮喘总药物的比例至少为0.5。我们计算了2003年哮喘急性发作的几率，作为每个质量指标表现的函数，并对种族、性别、年龄以及之前哮喘门诊和急性护理的使用情况进行了调整。
在加利福尼亚州（48.1%）和纽约州（51.9%）的90,909名患有持续性哮喘的受试者中，那些获得至少1次或至少4次控制药物的人出现不良结果的可能性增加（调整后的优势比分别为1.80 [95% CI，1.73 - 1.87]和1.44 [95% CI 1.40 - 1.48]）。符合控制药物与哮喘总药物比例指标的受益人急性发作的可能性降低23.0%（调整后的优势比为0.77 [95% CI，0.75 - 0.80]）。
较高的控制药物比例表明哮喘急性发作的可能性较低，而评估控制药物配药事件的数量与急性发作的较高几率相关。
