National Asthma Education and Prevention Program Working Group Report on the Financing of Asthma Care

Billings, John S.; Kretz, Sandra E.; Rose, Robin; Rosenbaum, Sara; Sullivan, Myrtis; Fowles, Jinnet B.; Weiss, Kevin B.

doi:10.1164/ajrccm/154.3_pt_2.s119

Cited by 16 publications

(6 citation statements)

References 9 publications

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“…A similar recommendation was made in 1996. 12 Public and private funding agencies should use their influence to move the asthma research community toward standardization of definitions, although arriving at such definitions is no easy feat, because it requires consensus and acceptance from multiple stakeholders.…”

Section: Discussionmentioning

confidence: 99%

Quality of Care for Childhood Asthma: Estimating Impact and Implications

et al. 2009

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We conducted a review of 164 relevant publications to consolidate the evidence on gaps in the quality of asthma care, the impact of those gaps, and the costs and benefits of closing those gaps. Researchers used a wide variety of definitions for measures of quality asthma care, clinical and utilization end points, and disease severity. Gaps in care were most evident for pharmacologic treatment, particularly the underuse of inhaled corticosteroids, with median usage rates of 40%; however, in studies with large proportions of black subjects, the inhaled corticosteroid usage rate was only 32%, compared with 51% for nonminority populations. Studies on outcomes focused on emergency department visits, hospital admissions, and missed school days. Because only 6 studies included information on the costs of improving asthma care, no consensus estimates of the cost/benefit ratio for better asthma care could be derived. There was insufficient evidence in the literature for assessment of the impact of gaps in care and the costs of closing those gaps. More economic evaluations of the impact of gaps in asthma care and of interventions to improve asthma control are needed. Future research on gaps in asthma care and their impact must use standardized definitions for key variables such as disease severity and care utilization to allow comparisons across studies and building of an evidence base that is convincing for policy makers and purchasers of care. Pediatrics 2009; 123:S199-S204 I N 2002, Ͼ30 million US individuals reported having been diagnosed as having asthma, including 122 per 1000 children (which made asthma the most common chronic disease among children) and 106 per 1000 adults. The prevalence of the disease remains at historically high levels. 1 In 2004, the total estimated annual costs of treating asthma were approximately $16.1 billion, of which $11.5 billion were direct costs. 2 Prescription drugs accounted for the largest single component of these direct costs ($5 billion), and hospital care represented one third of the $11.5 billion. 2 Although recent advances in pharmacotherapy have made asthma a highly treatable disease, research suggests that treatment often falls short of recommended care; according to a 2001 study, 3 74% of children with moderate/ severe asthma in a national sample did not receive adequate treatment. Despite their higher prevalence of disease, minority children are less likely than nonminority children to receive adequate treatment. 4 Two Rand studies showed that only 43% of adult patients and only 44% of children who used a rescue inhaler Ն3 times per day were given maintenance treatment. 5,6 Recognition by policy makers, providers, and the public of the discrepancies between recommended care and care that is actually received has led to initiatives to improve the quality of asthma care, such as the Healthy People 2010 initiative. 7 Although the quality of asthma care, treatment options, and the effects of the disease have been addressed extensively by the research community, ther...

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Section: Discussionmentioning

confidence: 99%

Quality of Care for Childhood Asthma: Estimating Impact and Implications

et al. 2009

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“…For example, the "National Asthma Education and Prevention Program Task Force Report on the Cost Effectiveness, Quality of Care, and Financing of Asthma Care" failed to mention air pollution as a factor in patient admissions for asthma. [20][21][22] It seems that current data from epidemiological and toxicological studies have not yet been translated into a general understanding and emphasis by physicians caring for patients with asthma. Since there is no skin test for air pollution exposure, it all too often goes unrecognized as an important factor in asthma exacerbations.…”

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confidence: 99%

Air Pollution as an Underappreciated Cause of Asthma Symptoms

Thurston¹

2003

JAMA

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“…While attempts to improve quality and reduce the financial costs of asthma are now commonplace in managed care, 19 there is little published evidence that these programs have been effective 20 . Previous research on the relationship between the financing of asthma care and quality of care found little empirical evidence and therefore a significant need for further understanding of this topic 21 …”

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confidence: 99%

Insurance and quality of care for adults with acute asthma

et al. 2002

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on behalf of the MARC Investigators OBJECTIVE: The relationship between health care insurance and quality of medical care remains incompletely studied. We sought to determine whether type of patient insurance is related to quality of care and subsequent outcomes for patients who arrive in the emergency department (ED) for acute asthma.DESIGN: Using prospectively collected data from the Multicenter Airway Research Collaboration, we compared measures of quality of pre-ED care, acute severity, and shortterm outcomes across 4 insurance categories: managed care, indemnity, Medicaid, and uninsured. SETTING AND PARTICIPANTS:Emergency departments at 57 academic medical centers enrolled 1,019 adults with acute asthma. RESULTS:Patients with managed care ranked first and uninsured patients ranked last on all 7 unadjusted quality measures. After controlling for covariates, uninsured patients had significantly lower quality of care than indemnity patients for 5 of 7 measures and had lower initial peak expiratory flow rates than indemnity insured patients. Patients with managed care insurance were more likely than indemnity-insured patients to identify a primary care physician and report using inhaled steroids in the month prior to arrival in the ED. Patients with Medicaid insurance were more likely than indemnity-insured patients to use the ED as their usual source of care for problems with asthma. We found no differences in patient outcomes among the insurance categories we studied.CONCLUSIONS: Uninsured patients had consistently poorer quality of care and than insured patients. Despite differences in indicators of quality of care between types of insurance, we found no differences in short-term patient outcomes by type of insurance. The increasing prevalence of asthma programs designed to decrease emergency department (ED) visits raises concerns about the potential for these programs to inappropriately delay care, resulting in greater morbidity. 9 Do managed care mechanisms designed to decrease unnecessary ED utilization influence the quality of care and short-term outcomes of patients who do end up presenting to the ED with acute asthma?We hypothesized that adults with acute asthma and no insurance would have worse quality of care and outcomes compared to patients with insurance. This hypothesis was based on conceptual models of the influence of insurance on quality of care. 1,22 We further hypothesized that if managed care interventions were effectively increasing quality, then managed care patients who did end up in the ED would 1) have better performance on measures of pre-ED quality of care, 2) be as sick or sicker than other patients by measures of acute severity, and 3) have a high rate of admission and a low relapse rate compared to patients with other types of health insurance. These hypotheses stem from the position that patients should be well-managed prior to ED presentation, should only end up in the ED when they are sick enough to require the specialized services, but once hospitalized should not have higher ...

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National Asthma Education and Prevention Program Working Group Report on the Financing of Asthma Care

Cited by 16 publications

References 9 publications

Quality of Care for Childhood Asthma: Estimating Impact and Implications

Quality of Care for Childhood Asthma: Estimating Impact and Implications

Air Pollution as an Underappreciated Cause of Asthma Symptoms

Insurance and quality of care for adults with acute asthma

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