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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Alexandra E. Shields, PhD1, Catherine Comstock, MPH1, and Kevin B. Weiss, MD2. (1) Institute for Health Care Research and Policy, Georgetown University, 2233 Wisconsin Ave, NW, Suite 525, Washington, DC 20007, 202-687-0880, shieldsa@georgetown.edu, (2) Department of Internal Medicine, Northwestern University, 633 Clark Street, Evanston, IL 60208
Context. While many studies have assessed trends in asthma outcomes among children with asthma enrolled in Medicaid managed care, few studies have examined differences in the underlying process of care received by children in these settings. Objective. To examine the extent to which care provided to African-American, Hispanic and white children enrolled in a state Medicaid primary care clinician plan (PCCM) follows recommended national guidelines. Design. Retrospective cohort study using Medicaid claims and enrollment data in Massachusetts for the 1993-1994 period. Study Population. African-American, Hispanic and Caucasian children (N=5773) children (2-18) in the Massachusetts Medicaid program who had an asthma diagnosis and were continuously enrolled in the state-administered PCCM plan in 1993 and 1994. Main Outcome Measures. Performance on 6 claims-based process of care measures that reflect aspects of pediatric asthma care recommended in national guidelines. Measures address routine primary care, access to specialists, appropriate asthma pharmacotherapy, and timely follow-up care after asthma emergency department (ED) visits and hospitalization. Results: Both African-American (O.R.:0.36; C.I.:0.18-0.73) and Hispanic (O.R.:0.59; C.I.: 0.36-0.95) children were significantly less likely than white children to receive a timely follow-up visit (within 5 days) after being seen in the ED for asthma. While Hispanic were 16% more likely than white children to receive a minimum of 2 asthma visits during the year (C.I.:1.01-1.34) and less likely to be overly reliant on beta-agonist medication (O.R.: 0.73; C.I.: 0.54-0.99), Hispanic children with persistent asthma were only 61% as likely as white children to have a visit with an asthma specialist at any time during the year. There were no group differences in use of anti-inflammatory medications or follow-up care after an asthma hospitalization. Conclusions. The process of care received by Medicaid-enrolled children with asthma differs significantly across racial/ethnic groups. Diminished access to asthma specialists among Hispanic children and poor follow-up care for both Hispanic and African-American children seen in the ED for asthma deserve further attention. The extent to which differences in the process of care may help explain excess asthma hospitalizations is a potentially fruitful area for future research.
Learning Objectives:
Keywords: Asthma, Medicaid Managed Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.