Boyd Melanie, Eyimina Arina, Brown Clare C, Goudie Anthony, Ararat Erhan, Rezaeiahari Mandana, Perry Tamara T, Tilford J Mick, Jefferson Akilah A
Department of Health Policy and Management, University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health, Little Rock, AR.
Pediatric Pulmonary Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
J Pediatr. 2025 Feb;277:114361. doi: 10.1016/j.jpeds.2024.114361. Epub 2024 Oct 19.
To evaluate the comparative effectiveness of allergy specialist care for children with asthma enrolled in the Arkansas Medicaid program.
We used the Arkansas All-Payers Claims Database to identify Medicaid-enrolled children with asthma who had an allergy specialist visit in 2018. These children were propensity score matched to children without an allergy specialist visit to evaluate differences in asthma-related adverse events (AAEs), specifically emergency department visits and/or hospitalizations in 2019. Multivariable logistic regression was used to assess the association between allergy specialist care in 2018 and AAEs in 2019.
Prior to matching, a higher percentage of children with an allergy specialist visit had persistent asthma, were atopic, and received influenza vaccination. In the matched sample, 10.1% of identified patients experienced an AAE in 2019. Adjusted analysis showed 21.0% lower odds of AAEs (aOR: 0.79; 95% CI: 0.63, 0.98) in 2019 for children with an allergy specialist visit (n = 2964) in 2018 compared with those without an allergy specialist visit (ME: 9.1% vs 11.0%; P = .04).
Children with asthma enrolled in Arkansas Medicaid who saw an allergy specialist were less likely to have an AAE. Asthma quality metrics developed using guideline-based recommendations for allergy specialist care should be considered for asthma health management programs.
评估阿肯色州医疗补助计划中哮喘患儿接受过敏专科护理的相对有效性。
我们使用阿肯色州全支付者索赔数据库，识别出2018年接受过过敏专科就诊的参加医疗补助计划的哮喘患儿。这些患儿根据倾向得分与未接受过敏专科就诊的患儿进行匹配，以评估哮喘相关不良事件（AAE）的差异，特别是2019年的急诊科就诊和/或住院情况。采用多变量逻辑回归分析评估2018年过敏专科护理与2019年AAE之间的关联。
在匹配之前，接受过敏专科就诊的患儿中，持续性哮喘、特应性体质以及接受流感疫苗接种的比例更高。在匹配样本中，2019年10.1%的已识别患者发生了AAE。校正分析显示，2018年接受过敏专科就诊的患儿（n = 2964）在2019年发生AAE的几率比未接受过敏专科就诊的患儿低21.0%（调整后比值比：0.79；95%置信区间：0.63，0.98）（分别为9.1%和11.0%；P = 0.04）。
参加阿肯色州医疗补助计划且看过过敏专科医生的哮喘患儿发生AAE的可能性较小。哮喘健康管理项目应考虑采用基于指南的过敏专科护理建议制定哮喘质量指标。
