The impact of care management for high-risk pediatric asthmatics on healthcare utilization

Abstract

Introduction

From 2011 to 2015, a series of quality improvement interventions were developed that targeted pediatric persistent asthmatics that included recalls for those overdue for care and access to specialist care. The objective of this study was to assess the impact on urgent care and emergency department visits and hospitalizations from enrollment into at least one intervention during the time period.

Methods

Persistent asthmatics were identified through electronic medical records, with patients having an asthma designation containing “persistent,” asthma control containing “poor”, and asthma risk being “high risk.” Asthma utilization events were identified for these patients between January 1, 2011, and June 30, 2015 using ICD-9 diagnosis codes. Evaluation focused on differences in utilization for patients before and after receiving interventions through the use of logistic regression for each utilization outcome.

Results

The interventions were delivered to 1060 children out of a total of 2046 identified as having the persistent asthmatic criteria. The intervention group consisted of 389 (36.7%) moderate persistent asthmatics and 643 (60.7%) mild persistent asthmatics, with 976 (92.1%) identifying as a minority. Analysis of 60692 months of data showed patients who received the intervention were less likely to visit the urgent care (OR [0.80, 0.96]) or be hospitalized (OR [0.37, 0.75]) than those who did not receive any interventions. Adjustment for provider referral into the interventions resulted in slight changes for both hospitalizations (OR [0.38, 0.79]) and urgent care (OR [0.68, 0.94]).

Conclusion

Children receiving interventions were less likely to be hospitalized or visit urgent care clinics.

Keywords:

• Asthma
• care management
• pediatric
• safety net

Acknowledgements

I would like to sincerely thank all of those who have contributed to this study in one way or another. I would like to express my sincere gratitude to Dr. Adam Atherly, as this could not have been completed without his mentoring. He provided insightful comments throughout the process, from providing critique for analysis design to reviewing the paper and providing rounds upon rounds of feedback. Without his guidance and encouragement, my research would most certainly not have reached this point. It has been a wonderful experience working with him.

I would also like express my sincere gratitude to Dr. Tracy Johnson, who, despite the project taking so long to complete, remained understanding and continuously provided suggestions and helpful critiques along the way, suggesting new ways of looking at the results and different interpretations that I otherwise would not have understood without having the context of how this fit in at Denver Health.

Special thanks to Dr. Mark Anderson, Carolyn Valdez, and Sarah Sabalot, all of whom provided valuable input in regards to the implementation of the study and Dr. Anderson for clinical insight into the programs. The tireless efforts of Dr. Johnson, Dr. Anderson, Ms. Valdez, and Ms. Sabalot in designing the asthma programs and implementing them have made conducting this analysis possible.

Conflict of interest

There is no funding for the study.

Declaration of interest and acknowledgements

Mr. Lou conducted the analysis in fulfillment of the health services research master’s program at the Colorado School of Public Health under the supervision of Dr. Atherly. There was no funding for the study.

Mr. Lou is the lead author on the paper and is currently an employee of Denver Health.

Additional information

Notes on contributors

Yingbo Lou

Yingbo Lou, MS. Mr. Lou originally conducted the analysis of the asthma programs as a master’s thesis project for the Colorado School of Public Health. He is currently working as an analyst in Ambulatory Services department at Denver Health, where he prepared the manuscript.

Adam Atherly

Adam Atherly, PhD. Dr. Atherly was the director of the Health Services Research program at the Colorado School of Public Health before becoming the director of the Center for Health Services Research at the Larner College of Medicine.

Tracy Johnson

Tracy Johnson, PhD. Dr. Johnson was thoroughly involved in the actuarial analysis of the asthma programs and the impacts on the managed care pediatric asthma population at Denver Health. She is currently the director for Health Reform Initiatives at Denver Health.

Mark Anderson

Mark Anderson, MD. Dr. Anderson was the clinical lead for the implementation of the asthma programs and is currently the lead for the pediatric asthma work group at Denver Health.

Carolyn Valdez

Carolyn Valdez, MS. Ms. Valdez is an analyst at Denver Health and was involved in establishing the preliminary analysis methods for this study.

Sarah Sabalot

Sarah Sabalot. Ms. Sabalot was involved in the design and implementation of the asthma programs at Denver Health and is currently the program administrator for the Patient-Centered Medical Home Team at the Swedish Medical Group.