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Changing criteria in a definition of high-risk asthma may help pinpoint those who will need the most care

The Health Effectiveness Data and Information Set (HEDIS) definition of high-risk asthma can help determine which young patients are likely to need interventions to manage their asthma, the most common chronic health condition affecting children and teens. However, because the definition casts a broad net, it often includes patients who are unlikely to need additional services.

Researchers compared the 2006 HEDIS definition with a revised definition they developed to determine which best predicted care use over 2 years for 769 youth ages 11 to 17 who were enrolled in an insurance plan in Washington. Both definitions include the criteria of more than one emergency department (ED) visit or hospitalization for asthma. However, the HEDIS definition criteria include more than four prescriptions for asthma medication or more than four ambulatory visits and more than two drug prescriptions for asthma. The revised definition dispenses with those criteria, and considers instead whether the patient received more than one oral steroid prescription for asthma. The revised definition for high-risk asthma identified 223 high-risk youth.

The HEDIS criteria included 514 youth, 295 of whom did not have asthma-related hospitalizations, ED visits, or prescriptions for oral steroids. In the second year, youth identified with the revised definition had more ED visits, more oral steroid prescriptions, and higher medical costs (an average of $600) than those identified with the HEDIS definition. Because the revised definition better predicted which patients with asthma will likely need additional services, it may help health plans put care management plans in place to forestall ED visits and hospitalizations, the authors suggest. This study was funded in part by the Agency for Healthcare Research and Quality (HS13853).

See "Identifying high-risk asthma with utilization data: A revised HEDIS definition," by Antonia V. Bennett, M.A., Paula Lozano, M.D., Laura P. Richardson, M.D., and others in the July 2008 American Journal of Managed Care 14(7), pp. 450-456.

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