Asthma Utilization among Children in Michigan Medicaid Programs

Transcription

1 Asthma Utilization among Children in Michigan Medicaid Programs May 2012 update

2 Why Medicaid data? High risk population important for MDCH activities Complete utilization data for individual Explore asthma management in with tremendous detail Opportunity to benchmark against national performance measures 2

3 Medicaid Population Children ages 17 years or younger Enrolled in Medicaid programs for 11 months in calendar year Full Medicaid coverage and no other source of health insurance Persistent asthma 4 asthma medication dispensing events, OR 1 ED visits where asthma was primary diagnosis (ICD- 9 = 493.xx), OR 1 hospitalization where asthma was primary diagnosis (ICD-9 = 493.xx), OR 4 outpatient visits where asthma was mentioned AND 2 asthma medication dispensing events 3

4 Data Notes Source is MDCH Data Warehouse Prevalence and rates are age-adjusted to 2000 US Standard Populations Data are not comparable to report

5 Detail for each of 13 indicators Rate or Prevalence of Indicator By sex By race By urban/rural status By county (map) 5

6 3 Asthma Burden Indicators among all Children in Medicaid Persistent asthma prevalence: proportion of beneficiaries meeting persistent asthma definition in year of measurement. Emergency department rate for asthma: number of ED visits with primary diagnosis of asthma per 10,000 children. represents number of visits, not number of persons Asthma Hospitalization rate: Number of in-patient hospitalizations with a primary discharge diagnosis of asthma per 10,000 children. represents number of hospitalizations, not persons hospitalized 6

7 Utilization Prevalence 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% Asthma Indicated Prevalence vs. Persistent Asthma Prevalence, Children ( 17 years), Medicaid, Michigan, Asthma Indicated: 1+ hospitalization or 1+ ED visit or 4+ dispensing events for asthma medications or 1+ OP visit. Persistent Asthma: 1+ hospitalization or 1+ ED visit or 4+ dispensing events for asthma medications or 4+ OP visit with 2+ asthma dispensing events. Asthma Indicated Persistent Asthma

8 Between 2005 and 2010, the prevalence of persistent asthma increased for male children (5.9% to 6.4%) and female children (4.3% to 4.6%) 7% 6% 5% 4% 3% 2% 1% 0% Prevalence of Persistent Asthma by Sex, Children ( 17 age), Medicaid, Michigan, Female Male

9 Prevalence of persistent asthma increased by 11.3% for black children, 4.0% for white children, and 26.2% for children of other races. 7% 6% 5% 4% Prevalence of Persistent Asthma by Race, Children ( 17 years), Medicaid, Michigan, Prevalence in black children was 9.9% higher than white children in This disparity increased to 17.5% in % 2% 1% 0% White Black Other

10 Among All Children in Medicaid Higher asthma prevalence were experienced by: Black children Males Children with rural residences Asthma ED visit rates remained constant Asthma hospitalization rates decreased 41% from 38.8 per 10,000 in 2005 to 22.9 per 10,000 in Disparities: Emergency Department rates 42% higher for males 119% higher for black children 104% higher for urban children Hospitalization rates 1.56 times higher for males 3.06 times higher for black children 2.10 times higher for urban residents

11 Rates of Emergency Department Visits and Hospitalizations for Asthma Rate of Asthma Emergency Department Visits by Race, Children ( 17 years) Medicaid, Michigan, Rate of Asthma Hospitalizations by Race, Children ( 17 years), Medicaid, Michigan, Rate per 10, Rate per 10, White Black Other White Black Other

12 Adverse Asthma Events Rate of Asthma ED Visits per 10,000, by County of Residence, Children ( 17 years), Medicaid, Michigan, 2010 Rate of Hospitalizations per 10,000, by County of Residence, Children ( 17 years), Medicaid, Michigan, 2010

13 5 Utilization Indicators among children with persistent asthma % of children with persistent asthma who had: 2 or more outpatient visits for asthma at least 1 ED visits due to Asthma 2 or more ED visits due to Asthma Reliance on ED for outpatient care for asthma Among kids with 1+ asthma outpatient or asthma ED visit [EDcount/(EDcount + OPcount)] at least 1 hospitalization due to asthma 13

14 According to national guidelines, persons with asthma should visit their primary care provider for routine asthma care at least twice a year. Improved for urban residents Worsened for rural residents In 2010, urban 16.9% more likely to have two or more OP visits. 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Percent of Children ( 17 years) with Persistent Asthma with 2 Outpatient Visits for Asthma by Urban/Rural Residence, Medicaid, Michigan, Rural Urban

15 Percent of Children ( 17 years) with Persistent Asthma with 2 Outpatient Visits for Asthma by County of Residence, Medicaid, Michigan, 2010 All counties below were statistically lower than the state proportion (28.7% ( )) except Baraga and Dickinson. ARENAC [11.6% ( )] CRAWFORD [14.7% ( )] ALPENA [15.3% ( )] GLADWIN [15.4% (8-22.8)] ANTRIM [16.2% ( )] ST JOSEPH [16.4% ( )] CLARE [16.5% ( )] MANISTEE [16.9% ( )] OSCEOLA [17.3% (8.6-26)] CASS [17.7% ( )] MENOMINEE [17.9% ( )] DICKINSON [18.1% ( )] BARAGA [18.3% ( )] IONIA [19.9% ( )]

16 Children with two or more ED visits per year are considered a high-risk population In 2010, 23% had one ED visit 6.0% had two or more ED visits Constant since 2005 Black children > White Children

17 Emergency department reliance is an indicator of primary care utilization within an hospital setting as opposed to a doctor s office. In 2010, urban residents were 60.0% more likely to rely on ED for primary care compared to rural residents. 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Percent of Reliance on Emergency Department among Children ( 17 years) with Persistent Asthma by Urban/Rural, Medicaid, Michigan, Rural Urban

18 Percent of Reliance on Emergency Department among Children ( 17 years) with Persistent Asthma by County of Residence, Medicaid, Michigan, 2010 Counties with a prevalence higher than the state prevalence of 28.7% ( ) are: Crawford, Oceana, Wayne, St. Joseph, Saginaw, Macomb, Kalamazoo, Ionia, and Oakland.

19 Percent of Children ( 17 years) with Persistent Asthma with 1 Hospitalization for Asthma by Race, Medicaid, Michigan, Percent of Children ( 17 years) with Persistent Asthma with 1 Hospitalization for Asthma by Urban/Rural, Medicaid, Michigan, % 10% 8% 8% 6% 6% 4% 4% 2% 2% 0% % White Black Other Rural Urban

20 4 Pharmacy Utilization Indicators among children with persistent asthma % who had: suspected overuse of SABA (13+ prescriptions filled) at least 1 prescription filled for ICS medication at least 1 prescription filled for any LTC medication 2+ prescriptions filled for an oral corticosteroid claims evidence of receipt of spirometry services 20

21 In 2010, SABA overuse is not significantly different by: - Sex - Race - Urban/rural residence

22 % filling 1 ICS increased 65.2% to 67.3% 1 LTC prevalence is constant 78.3%. In 2010

23 Long Term Control Medication Fills Black children were less likely than white children to have preventive utilization

24 2 or more OC prescriptions Urban residents were about 20% more likely to have 2+ OC compared to rural residents Arenac, Jackson, Macomb, Oakland, and Genesee higher than the state prevalence

25 Exploratory indicator.

26 13 indicators Measures All Children in Medicaid % Change Persistent Asthma (%) 5.1 ( ) 5.5 ( ) 7.7 ED Rate Per 10, ( ) ( ) - Hospitalization Rate Per 10, ( ) 22.9 ( ) All Children in Medicaid w/ Persistent Asthma Had 2+ Outpatient Visits (%) 26.9 ( ) 28.7 ( ) 6.6 Had 1+ ED Visit (%) 29.5 ( ) 27.8 ( ) -5.7 Had 2+ ED Visits (%) 6.5 ( ) 6.0 ( ) - ED Reliance For Primary Care (%) 31.8 ( ) 28.7 ( ) -9.5 Had 1+ Hospitalizations (%) 6.4 ( ) 3.6 ( ) SABA Overuse (%) 12.8 ( ) 13.0 ( ) - Had 1+ Inhaled Corticosteriod (%) 65.2 ( ) 67.3 ( ) 3.2 Had 1+ Long Term Controller (%) 78.6 ( ) 78.3 ( ) - Had 2+ Oral Corticosteriod (%) 18.5 ( ) 20.1 ( ) 8.7 Had 1+ Spirometry (%) 10.0 ( ) 11.4 ( ) 13.8

27 Indicators by Year for State Measu Year Total Female Male Black Other White Rural Urban re ( ) 4.3 ( ) 5.9 ( ) 5.6 ( ) 3.8 ( ) 5.1 ( ) 5.4 ( ) 5.1 ( ) ( ) 4.3 ( ) 6.0 ( ) 5.5 ( ) 4.0 ( ) 5.1 ( ) 5.6 ( ) 5.0 ( ) Persist ent 2007 Asthm 2008 a (%) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) 4.5 ( ) 6.2 ( ) 6.1 ( ) 4.6 ( ) 5.1 ( ) 5.6 ( ) 5.3 ( ) ( ) 4.6 ( ) 6.4 ( ) 6.2 ( ) 4.8 ( ) 5.3 ( ) 5.8 ( ) 5.5 ( ) ( ) 5.4 ( ) 6.3 ( ) 10.2 ( ) 4.9 ( ) 2.8 ( ) 2.3 ( ) 6.8 ( ) Had ( ) 6.0 ( ) 6.3 ( ) 10.8 ( ) 4.2 ( ) 2.6 ( ) 2.3 ( ) 7.0 ( ) 2+ ED Visits ( ) 5.6 ( ) 6.3 ( ) 10.2 ( ) 4.9 ( ) 2.8 ( ) 2.0 ( ) 6.9 ( ) (%) ( ) 5.7 ( ) 6.4 ( ) 10.4 ( ) 5.5 ( ) 3.0 ( ) 2.1 ( ) 7.0 ( ) ( ) 5.8 ( ) 6.1 ( ) 10.2 ( ) 5.8 ( ) 3.0 ( ) 2.4 ( ) 6.8 ( )

28 For each county County Prevalence (%) of Persistent Asthma Emergency Department Rate Per 10,000 Hospitalization Rate Per 10,000 State Prevalence/Rate 5.5 ( ) ( ) 22.9 ( ) ALCONA 5.9 ( ) * * ALGER - ALLEGAN 4.9 ( ) 92.0 ( ) 8.3 ( ) ALPENA 6.5 ( ) 86.7 ( ) * ANTRIM 4.9 ( ) 34.6 ( ) * ARENAC 4.8 ( ) ( ) * BARAGA 5.6 ( ) ( ) * BARRY 6.8 ( ) ( ) * BAY 5.4 ( ) ( ) 15.5 ( ) BENZIE 5.0 ( ) 88.3 ( ) * BERRIEN 6.4 ( ) ( ) 10.3 ( ) BRANCH 4.9 ( ) ( ) 13.7 ( ) CALHOUN 5.0 ( ) ( ) 9.8 ( ) CASS 5.4 ( ) 76.8 ( ) * CHARLEVOIX 4.9 ( ) ( ) * CHEBOYGAN 6.1 ( ) 59.8 ( ) * CHIPPEWA 4.8 ( ) 94.2 ( ) * CLARE 6.4 ( ) ( ) * CLINTON 6.6 ( ) ( ) 19.4 ( ) CRAWFORD 4.7 ( ) ( ) * DELTA 8.4 ( ) 85.4 ( ) * DICKINSON 4.2 ( ) 63.3 ( ) * EATON 6.3 ( ) ( ) 21.8 ( )

29 Other summary tables in report: Black White Black-White Ratio Measure % Change 2005 to % Change 2005 to Among All Children in Medicaid Persistent Asthma (%) 5.6 ( ) 6.2 ( ) ( ) 5.3 ( ) ED Rate Per 10, ( ) ( ) ( ) ( ) Hospitalizations Per 10, ( ) 40.3 ( ) ( ) 13.1 ( ) Among All Children in Medicaid with Persistent Asthma Had 2+ Outpatient Visits (%) 24.1 ( ) 26.6 ( ) ( ) 29.1 ( ) Had 1+ ED Visit (%) 44.4 ( ) 42.8 ( ) ( ) 17.9 ( ) Had 2+ ED Visits (%) 11.1 ( ) 10.2 ( ) ( ) 3.0 ( ) ED Reliance (%) 44.9 ( ) 40.9 ( ) ( ) 19.2 ( ) Had 1+ Hospitalization (%) 9.9 ( ) 5.5 ( ) ( ) 2.3 ( ) SABA Overuse (%) 13.9 ( ) 13.0 ( ) ( ) 13.0 ( ) Had 1+ Inhaled Corticosteriod (%) Had 1+ Long Term Control (%) Had 2+ Oral Corticosteriod (%) 63.1 ( ) 65.9 ( ) ( ) 67.1 ( ) ( ) 70.4 ( ) ( ) 83.1 ( ) ( ) 19.1 ( ) ( ) 20.2 ( ) Had Spirometry (%) 9.3 ( ) 11.7 ( ) ( ) 10.9 ( ) - - -

30 Citation: Garcia, E and Lyon-Callo S. Asthma Burden for Children in Medicaid. Epidemiology of Asthma in Michigan. Bureau of Epidemiology, Michigan Department of Community Health, For an electronic copy go to: This surveillance publication was supported by Cooperative Agreement Number U59/CCU from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

31 Grateful Acknowledgements Kevin Dombkowski, University of Michigan Child Health Evaluation and Research Unit Betsy Wasilevich (now BCBS-MI) Susan Moran and Cynthia Edwards, MDCH Medical Services Administration 31