A Longitudinal Examination of the Asthma Medication Ratio in Children with Medicaid

Abstract

Background/Objective: An efficient and accurate strategy for identifying children with asthma at high-risk for exacerbation is needed. The objective of this study is to conduct a longitudinal examination of the asthma medication ratio (AMR) (#of controller medication claims/(# of controller medication claims + # of rescue medication claims)) in Medicaid-funded children with asthma. This measure has the potential to be a near real-time risk assessment tool.

Methods: We conducted a retrospective analysis of 2013–2014 Truven Health Medicaid data. We analyzed pharmacy and medical claims for a cohort of children with asthma. We identified patients age 2–17 years with at least one claim for an inhaled corticosteroid. We calculated an AMR for rolling 3-month periods and examined the proportion who were classified as low risk (AMR ≥ .5), high-risk (AMR < .5) and no medication claims (no asthma medication claims). Using logistic regression, we tested how the AMR predicted severe exacerbations.

Results: 214,452 eligible children were identified. The mean age is 7.8 years. 8–9% had a high-risk AMR in any given period. High-risk AMR is associated with increased odds of a severe exacerbation in the subsequent 3 months (compared to all other children) (OR 1.7–1.9 depending on time period evaluated).

Conclusions: In this analysis of Medicaid-insured children with asthma, we found that the AMR is a reliable predictor of exacerbations. This will inform the development of an AMR-based risk assessment and communication intervention.

Keywords:

• Control/management
• pediatrics
• prevention
• treatment

Additional information

Funding

This research was supported by the South Carolina Clinical and Translational Research (SCTR) Institute, with an academic home at the Medical University of South Carolina, National Institutes of Health/National Center for Advancing Translational Sciences (grants KL2 TR001452 and UL1 TR001450) and the Doris Duke Charitable Foundation (grant 2015209).