Evaluating an asthma disease management program: examining health care utilization with regard to persistent asthma

Main Article Content

Chun-Mei Lin
Ming-Chin Yang
Chinho Lin

Abstract

Asthma is a chronic disease that imposes a considerable burden on health care systems. Enhanced asthma management programs may reduce hospital admissions and improve patient satisfaction. The study investigates the quality-of-care and health care utilization of asthma patients by analyzing medical and pharmacy claims to provide opportunities for optimizing asthma disease management. We performed a retrospective cross-sectional study using Taiwan’s National Health Insurance claims database. We assessed health care utilization, cost and medication for patients. Patients were divided into four groups according to whether or not they were enrolled in an asthma disease management program and whether or not they had persistent asthma.Out of the total of 543,640 patients, 146,315 (27%) had persistent asthma and 397,325 (73%) had non-persistent asthma. Patients with persistent asthma who had enrolled in an asthma management program had a low rate of asthma-related hospitalizations and emergency department visits compared to patients with persistent asthma who were not enrolled in such a program (0.04% vs. 0.10%, 0.14% vs. 0.45%, respectively). In addition, patients with persistent asthma who were enrolled in an asthma management program had a high rate of inhaled corticosteroid use (ICS) (63% vs. 49%, respectively) compared to patients with persistent asthma who were not enrolled in such a program.The results of the study show that persistent asthma patients who were enrolled in an asthma disease management program tended to have a decreased rate of asthma-related hospitalizations and emergency department visits as compared to those who were not enrolled in a program.

Article Details

Section
Person-centered care and chronic disease

References

References

Global Initiative for Asthma (GINA) GINA report global strategy for asthma management and prevention updated 2010. Available at http://www.ginasthma.org/Guidelineitem.asp??l1=2&l2=1&intId=60 (last accessed 23 May 2011).

Armesto, S. G. et al. (2007). Health care quality indicators project 2006 data collection update report. OECD Health Working Paper No. 22, OECD, Paris.

Agency for Healthcare Research and Quality (AHRQ) (2009). National healthcare disparities report 2009. AHRQ Publication.

Lin, C. M. (2009). Developing asthma quality-of-care indicators from claims. Taiwan Bureau of National Health Insurance, Taipei (in Chinese).

Blaiss, M. S. (2005) Asthma disease management: a critical analysis. Annals of Allergy, Asthma & Immunology, 95(5Suppl 1), S10–S16.

Stoloff, S.W. (2008). Asthma management and prevention: Current perspectives. Clinical Cornerstone, 8(4), 26-43.

Steuten, L. et al. (2007). Cost-utility of a disease management program for patients with asthma. International Journal of Technology Assessment in Health Care, 23(2), 184-191.

Taiwan Bureau of National Health Insurance (TBNHI) Pay-for-Performance Plans. Available at http://www.nhi.gov.tw/english/index.aspx (last accessed 23 May 2011).

Velasco-Garrido M., Busse R. and Hisashige A. (2003). Are disease management programmes (DMPs) effective in improving quality of care for people with chronic conditions? Copenhagen, WHO Regional Office for Europe. Available at http://www.euro.who.int/document/e82974.pdf (last accessed 23 May 2011).

Chapman, K. R. (2003). The impact of budesonide and other inhaled corticosteroid therapies in the management of asthma in children and adults. Clinical therapeutics, 25(suppl): C2-C14.

Klomp, H. (2008). Examining asthma quality of care using a population-based approach. Canadian Medical Association Journal, 178(8), 1013-21.

OECD (2009). Health at a Glance 2009 - OECD Indicators. OECD, Paris.

National Quality Measures Clearinghouse (NQMC) Browse - disease/condition Results. Available at http://www.qualitymeasures.ahrq.gov/browse/browsemode.aspx?node=2528&type=1 (last accessed 23 May 2011).

AHRQ: Effectiveness of care: respiratory diseases, Available at http://www.ahrq.gov/qual/nhqr06/measurespec/respdis.htm (last accessed 23 May 2011).

Australian Centre for Asthma Monitoring (2008). Asthma in Australia 2008. Australian Institute of Health and Welfare, Canberra.

Braman, S. S. and Hanania, N. A. (2007). Asthma in older adults. Clinics in Chest Medicine, 28(4), 685-702.

Galbreath, A. D. et al. (2008). Assessing the value of disease management: impact of 2 disease management strategies in an underserved asthma population. Annals of Allergy, Asthma and Immunology, 101(6), 599-607.

National Healthcare Quality Report Disparities (NHQRDRnet) Management of asthma. Available at http://nhqrnet.ahrq.gov/nhqrdr/jsp/nhqrdr.jsp?catId=20101&msrId=&tableTypeId=#snhere (last accessed 23 May 2011).

Schneider, A. et al. (2008). Impact of quality circles for improvement of asthma care: results of a randomized controlled trial. Journal of Evaluation in Clinical Practice, 14(2), 185-190.

Busse,W. W. et al.( 2008). The inhaled steroid treatment as regular therapy in early asthma (START) study 5-year follow-up: Effectiveness of early intervention with budesonide in mild persistent asthma. American Academy of Allergy, Asthma & Immunology, 121(5), 1167-74.

Morishima, T et al. (2011). Physician adherence to asthma treatment guidelines in Japan: focus on inhaled corticosteroids. Journal of Evaluation in Clinical Practice, doi: 10.1111/j.1365-2753.2011.01708.x.

Gelfand, E. W. et al. (2006). Use of the health plan employer data and information set for measuring and improving the quality of asthma care. Annals of Allergy Asthma and Immunology, 97, 298–305.

Weingarten S.R. et al. (2002). Interventions used in disease management programs for patients with chronic illness-which ones work? Meta-analysis of published reports. British Medical Journal, 325, 1-8.