Estimating the impact of self-management education, influenza vaccines, nebulizers, and spacers on health utilization and expenditures for Medicaid-enrolled children with asthma

Figures & data

Figure 1. Cost trendlines for AS-ME.

Abbreviation: AS-ME – Asthma self-management education.

Figure 2. Probability of utilization trendlines for AS-ME.

Abbreviations: AS-ME – Asthma self-management education, ED – Emergency department, IP – Inpatient (hospitalization), PCP – Primary care physician.

Table 1. Variable comparison for control and intervention (New York).

	AS-ME				Influenza Vaccine
Population	Control		Intervention		Control		Intervention
Year	2010	2011	2010	2011	2010	2011	2010	2011
Number of patients	57804	57804	1566	1566	50948	50948	6856	6856
Utilization (Mean, Std)
ED visit per patient	0.35 (0.07)	0.35 (0.09)	0.55 (0.14)	0.43 (0.13)	0.36 (0.15)	0.36 (0.15)	0.27 (0.09)	0.28 (0.1)
IP visit per patient	0.07 (0.003)	0.05 (0.002)	0.17 (0.008)	0.08 (0.003)	0.07 (0.004)	0.05 (0.003)	0.06 (0.005)	0.03 (0.002)
PCP visit per patient	0.80 (0.20)	0.74 (0.14)	2.42 (1.02)	1.47 (0.78)	0.78 (0.19)	0.70 (0.18)	1.06 (0.21)	0.97 (0.14)
Non-asthma ED visit per patient	0.93 (0.12)	0.89 (0.10)	0.97 (0.18)	0.86 (0.14)	0.91 (0.16)	0.89 (0.13)	1.05 (0.27)	0.95 (0.12)
Medication adherence (Mean, Std)
ASM	0.91 (0.009)	0.93 (0.011)	0.95 (0.02)	0.95 (0.04)	0.91 (0.08)	0.93 (0.004)	0.94 (0.01)	0.95 (0.005)
AMR	0.65 (0.05)	0.66 (0. 05)	0.65 (0. 05)	0.67 (0. 05)	0.64 (0. 05)	0.65 (0. 05)	0.69 (0. 06)	0.70 (0. 06)
MMA	0.37 (0.04)	0.40 (0.03)	0.36 (0.04)	0.42 (0.03)	0.36 (0.04)	0.40 (0.04)	0.39 (0.03)	0.44 (0.04)
Demographic characteristics (%)
Age 9–17	42.88	50.06	35.95	43.93	43.53	50.66	38.10	45.64
Urban	53.83	53.83	50.21	50.21	54.58	54.58	48.25	48.25
Suburban	22.17	22.17	21.23	21.23	21.42	21.42	27.75	27.75
Intervention (%)
Patient with spacer	0.74	5.53	2.81	7.92	0.70	5.53	1.01	5.51
Patient with nebulizer	22.53	21.73	44.89	27.97	22.31	21.88	24.18	20.60
Patient with influenza vaccine	11.86	11.46	13.73	12.52	0	8.45	100	33.78
Patient with AS-ME	0	0	100	0	0	0	0	0
	Spacer				Nebulizer
Population	Control		Intervention		Control		Intervention
Year	2010	2011	2010	2011	2010	2011	2010	2011
Number of patients	52655	52655	1814	1814	37256	37256	7989	7989
Utilization (Mean, Std)
ED visit per patient	0.33 (0.05)	0.33 (0.05)	0.55 (0.13)	0.48 (0.11)	0.18 (0.07)	0.16 (0.07)	0.60 (0.27)	0.33 (0.12)
IP visit per patient	0.06 (0.002)	0.05 (0.002)	0.16 (0.007)	0.09 (0.005)	0.03 (0.002)	0.02 (0.002)	0.11 (0.005)	0.07 (0.002)
PCP visit per patient	0.76 (0.27)	0.72 (0.27)	1.31 (0.45)	1.20 (0.37)	0.60 (0.11)	0.56 (0.13)	1.27 (0.39)	0.89 (0.25)
Non-asthma ED visit per patient	0.89 (0.17)	0.87 (0.12)	1.32 (0.37)	1.13 (0.35)	0.79 (0.14)	0.79 (0.12)	1.20 (0.51)	1.00 (0.47)
Medication adherence (Mean, Std)
ASM	0.92 (0.01)	0.93 (0.013)	0.85 (0.08)	0.89 (0.07)	0.95 (0.02)	0.96 (0.03)	0.87 (0.05)	0.91 (0.03)
AMR	0.66 (0.06)	0.66 (0.08)	0.61 (0.07)	0.66 (0.07)	0.69 (0.08)	0.69 (0.06)	0.60 (0.07)	0.64 (0.07)
MMA	0.36 (0.02)	0.40 (0.04)	0.36 (0.03)	0.39 (0.04)	0.37 (0.03)	0.42 (0.05)	0.36 (0.03)	0.40 (0.04)
Demographic characteristics (%)
Age 9–17	44.82	52.03	21.83	27.34	49.06	56.60	32.48	38.49
Urban	52.56	52.56	59.65	59.65	49.38	49.38	56.67	56.67
Suburban	23.44	23.44	16.35	16.35	26.62	26.62	19.33	19.33
Intervention (%)
Patient with Spacer	0	0	100	0	0.31	4.05	2.03	5.91
Patient with nebulizer	19.45	20.45	92.28	28.89	0	0	100	0
Patient with influenza vaccine	11.85	11.42	11.74	10.64	11.86	11.62	12.82	11.10
Patient with AS-ME	0	0	0	0	0	0	0	0

Abbreviations: AMR – Asthma medication ratio, ASM – Appropriate medications for people with asthma, AS-ME – Asthma self-management education, ED – Emergency department, IP – Inpatient (hospitalization), PCP – Primary care physician, Std – Standard deviation.

Table 2. Variable comparison for control and intervention populations (Michigan).

	AS-ME				Influenza vaccine
Population	Control		Intervention		Control		Intervention
Year	2010	2011	2010	2011	2010	2011	2010	2011
Number of patients	13643	13643	475	475	9517	9517	4126	4126
Utilization (Mean, Std)
ED visit per patient	0.36 (0.07)	0.32 (0.06)	0.82 (0.23)	0.41 (0.17)	0.40 (0.13)	0.35 (0.11)	0.28 (0.1)	0.25 (0.09)
IP visit per patient	0.05 (0.003)	0.03 (0.003)	0.08 (0.004)	0.04 (0.002)	0.05 (0.003)	0.04 (0.003)	0.04 (0.003)	0.02 (0.003)
PCP visit per patient	1.61 (0.40)	1.30 (0.28)	2.21 (1.02)	1.35 (0.52)	1.47 (0.24)	1.22 (0.19)	1.93 (0.19)	1.49 (0.38)
Non-asthma ED visit per patient	1.00 (0.15)	0.86 (0.10)	1.26 (0.22)	1.34 (0.14)	0.98 (0.12)	0.84 (0.11)	1.05 (0.32)	0.90 (0.31)
Medication adherence (Mean, Std)
ASM	0.28 (0.04)	0.91 (0.05)	0.36 (0.09)	0.91 (0.04)	0.27 (0.05)	0.90 (0.02)	0.30 (0.07)	0.94 (0.01)
AMR	0.21 (0.01)	0.63 (0.09)	0.27 (0.02)	0.59 (0.1)	0.20 (0.01)	0.61 (0.12)	0.22 (0.01)	0.68 (0.15)
MMA	0.11 (0.007)	0.34 (0.05)	0.16 (0.006)	0.45 (0.05)	0.11 (0.004)	0.33 (0.05)	0.13 (0.004)	0.35 (0.06)
Demographic characteristics (%)
Age 9–17	49.1	58.5	45.5	54.9	51.5	60.5	43.5	53.8
Urban	43.0	43.0	39.6	39.6	45.4	45.4	37.7	37.7
Suburban	45.7	45.7	48.6	48.6	43.7	43.7	50.4	50.4
Intervention (%)
Patient with Spacer	16.9	9.8	24.4	8.6	14.9	9.1	21.4	11.6
Patient with nebulizer	43.2	34.9	59.8	40.2	43.4	35.5	42.7	33.5
Patient with influenza vaccine	30.2	25.5	29.1	25.5	0	16.6	100	46.1
Patient with AS-ME	0	0	100	0	0	0	0	0
	Spacer				Nebulizer
Population	Control		Intervention		Control		Intervention
Year	2010	2011	2010	2011	2010	2011	2010	2011
Number of patients	10426	10426	1875	1875	5980	5980	2903	2903
Utilization (Mean, Std)
ED visit per patient	0.36 (0.05)	0.31 (0.05)	0.35 (0.05)	0.28 (0.03)	0.62 (0.28)	0.55 (0.11)	0.50 (0.09)	0.12 (0.04)
IP visit per patient	0.04 (0.002)	0.03 (0.002)	0.05 (0.002)	0.03 (0.002)	0.07 (0.002)	0.05 (0.002)	0.05 (0.002)	0.02 (0.002)
PCP visit per patient	1.56 (0.41)	1.24 (0.38)	1.92 (0.4)	1.26 (0.22)	2.72 (1.02)	2.16 (0.81)	1.92 (0.52)	1.12 (0.37)
Non-asthma ED visit per patient	0.94 (0.17)	0.81 (0.12)	1.11 (0.29)	0.42 (0.32)	0.62 (0.14)	0.52 (0.12)	1.13 (0.38)	1.23 (0.31)
Medication adherence (Mean, Std)
ASM	0.27 (0.09)	0.90 (0.07)	0.38 (0.08)	0.95 (0.03)	0.30 (0.1)	0.99 (0.008)	0.28 (0.07)	0.95 (0.03)
AMR	0.20 (0.01)	0.62 (0.07)	0.27 (0.01)	0.67 (0.08)	0.23 (0.01)	0.69 (0.09)	0.20 (0.01)	0.67 (0.1)
MMA	0.11 (0.009)	0.34 (0.04)	0.17 (0.006)	0.34 (0.09)	0.12 (0.006)	0.36 (0.01)	0.12 (0.006)	0.35 (0.01)
Demographic characteristics (%)
Age 9–17	54.5	63.7	31.9	42.5	58.8	68.5	43.6	53.1
Urban	44.3	44.3	38.1	38.1	35.0	35.0	42.5	42.5
Suburban	44.2	44.2	50.6	50.6	51.0	51.0	46.2	46.2
Intervention (%)
Patient with spacer	0	0	100	0	14.7	7.6	20.5	9.6
Patient with nebulizer	41.1	33.6	49.2	34.5	0	0	100	0
Patient with influenza vaccine	28.2	24.5	37.5	28.5	30.7	25.7	31.3	25.9
Patient with AS-ME	0	0	0	0	0	0	0	0

Abbreviations: AMR – Asthma medication ratio, ASM – Appropriate medications for people with asthma, AS-ME – Asthma self-management education, ED – Emergency department, IP – Inpatient (hospitalization), PCP – Primary care physician, Std – Standard deviation.

Figure 3. Summary results for intervention effects (New York).

Notes: Calculations performed with using Supplementary Tables S1 and S2. Utilizations are transformed to % changes by DiD estimator × 100 and costs are transformed with using eDiD estimator - 1 × 100. Abbreviations: AS-ME – Asthma self-management education, ED – Emergency department, IP – Inpatient (hospitalization), PCP – Primary care physician.

Figure 4. Summary results for intervention effects (Michigan).

Notes: Calculations performed with using Supplementary Tables S1 and S2. Utilizations are transformed to % changes by DiD estimator × 100 and costs are transformed with using eDiD estimator - 1 × 100. Abbreviations: AS-ME – Asthma self-management education, ED – Emergency.