利用医疗补助计划（Medicaid）的索赔数据来识别哮喘儿童。

Using Medicaid claims to identify children with asthma.

机构信息

Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA.

出版信息

J Public Health Manag Pract. 2012 May-Jun;18(3):196-203. doi: 10.1097/PHH.0b013e31821a3fa7.

DOI:10.1097/PHH.0b013e31821a3fa7

PMID:22473110

Abstract

OBJECTIVE

To assess the accuracy of using administrative data from state-managed programs to identify children with asthma in a statewide immunization information system. We wished to understand the degree to which alternative asthma case definitions applied to administrative data influence the accuracy of cases identified in an immunization information system.

DESIGN & SETTING: Children aged 2 to 18 years were sequentially classified into 3-case definition groups on the basis of Michigan Department of Community Health administrative data (2005-2006): (1) children with a Children's Special Health Care Services (CSHCS) Program qualifying diagnosis of asthma (CSHCS cases); (2) those having 1 or more asthma medication claims (Rx cases); or (3) those without asthma medications having 1 or more health services claim reporting an asthma diagnosis code (Dx cases).

PARTICIPANTS

Children were randomly selected from each asthma case definition group; parents were invited to participate in a telephone interview to document physician diagnosis of asthma, symptoms, activity limitations, medications, and asthma health services use.

MAIN OUTCOME MEASURES

The positive predictive value of parent report of a physician diagnosis of asthma; asthma severity, based on National Asthma Education and Prevention Program criteria.

RESULTS

: Of 440 completed interviews, 89% of parents confirmed the child's high-risk status, reporting physician diagnosis of asthma (83%), wheezy-cough (5%), or reactive airway disease (1%). The positive predictive value varied for CSHCS cases (100%), Rx cases (91%) and Dx cases (73%, P < .0001). Although reported asthma severity levels were similar among CSHCS and Rx cases (P = .9100), asthma severity was lower among Dx cases (P = .0218).

CONCLUSIONS

Medicaid administrative data can be used to accurately identify children with asthma and represents a feasible approach for Medicaid programs and health plans to identify priority groups for targeted influenza vaccination reminders.

摘要

目的

评估使用州管理项目的行政数据来识别全州免疫信息系统中儿童哮喘的准确性。我们希望了解替代哮喘病例定义应用于行政数据对免疫信息系统中识别病例的准确性的影响程度。

设计和设置

根据密歇根州社区卫生署行政数据（2005-2006 年），将 2 至 18 岁的儿童依次分为 3 种病例定义组：（1）儿童特殊医疗保健服务（CSHCS）计划有哮喘合格诊断（CSHCS 病例）的儿童；（2）有 1 次或多次哮喘药物报销（Rx 病例）的儿童；或（3）无哮喘药物但有 1 次或多次健康服务报销报告哮喘诊断代码（Dx 病例）的儿童。

参与者

从每个哮喘病例定义组中随机选择儿童；邀请家长参加电话访谈，以记录医生诊断的哮喘、症状、活动受限、药物和哮喘健康服务的使用情况。

主要结果测量

家长报告医生诊断的哮喘的阳性预测值；根据国家哮喘教育和预防计划标准，哮喘严重程度。

结果

在 440 次完成的访谈中，89%的家长确认了孩子的高危状态，报告了医生诊断的哮喘（83%）、喘息咳嗽（5%）或反应性气道疾病（1%）。CSHCS 病例（100%）、Rx 病例（91%）和 Dx 病例（73%，P<.0001）的阳性预测值不同。尽管 CSHCS 和 Rx 病例报告的哮喘严重程度水平相似（P=.9100），但 Dx 病例的哮喘严重程度较低（P=.0218）。