PMID- 20469953
OWN - NLM
STAT- MEDLINE
DCOM- 20100818
LR  - 20151119
IS  - 1936-2692 (Electronic)
IS  - 1088-0224 (Linking)
VI  - 16
IP  - 5
DP  - 2010 May
TI  - Relationship of asthma control to asthma exacerbations using surrogate markers 
      within a managed care database.
PG  - 327-33
AB  - OBJECTIVE: To compare the relationship of surrogate markers of asthma control to 
      subsequent asthma exacerbations. STUDY DESIGN: Retrospective cohort. METHODS: 
      Administrative data were used to identify patients who met the Healthcare 
      Effectiveness Data and Information Set (HEDIS) criteria for persistent asthma in 
      2006 and 2007. The following potential surrogate markers of asthma control 
      assessed in 2007 were compared for their ability to predict asthma exacerbations 
      in 2008 (defined as oral corticosteroid dispensing or an asthma hospitalization 
      or emergency department visit): dispensing of any controller, unweighted 
      medication ratio (the ratio of controller to total medication), weighted 
      medication ratio, and the number of short-acting beta-agonist (SABA) canisters 
      dispensed. Weighted medication ratios were weighted for controller potency and 
      for doses per container. RESULTS: Meeting the HEDIS criteria for persistent 
      asthma were 8634 patients (60.5% female) aged 18 to 56 years (mean age, 42.7 
      years), of whom 6.5% experienced emergency hospital care and 27.3% received oral 
      corticosteroids in 2008. The largest effect size for predicting reduced emergency 
      hospital care was for the number of SABA canisters dispensed (odds ratio [OR], 
      0.49; 95% confidence interval [CI], 0.40-0.60), followed by the unweighted 
      medication ratio (OR, 0.54; 95% CI, 0.40-0.72), and then the weighted medication 
      ratio (OR, 0.57; 95% CI, 0.45-0.73). Dispensing of any controller was associated 
      with a nonsignificant increased risk of emergency hospital care (OR, 1.41; 95% 
      CI, 0.95-2.09). CONCLUSIONS: The number of SABA canisters dispensed is most 
      strongly related to improved asthma outcomes, followed by the unweighted 
      medication ratio; dispensing of any controller is least related. Health plans can 
      use the number of SABA canisters dispensed and the unweighted medication ratio 
      for asthma population management or for provider quality-of-care assessment to 
      reduce asthma exacerbations, which exact a high economic and humanistic cost.
FAU - Schatz, Michael
AU  - Schatz M
AD  - Department of Allergy, Kaiser Permanente Medical Center, 7060 Clairemont Mesa 
      Blvd, San Diego, CA 92111, USA. michael.x.schatz@kp.org
FAU - Zeiger, Robert S
AU  - Zeiger RS
FAU - Yang, Su-Jan T
AU  - Yang SJ
FAU - Chen, Wansu
AU  - Chen W
FAU - Crawford, William W
AU  - Crawford WW
FAU - Sajjan, Shiva G
AU  - Sajjan SG
FAU - Allen-Ramey, Felicia
AU  - Allen-Ramey F
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Manag Care
JT  - The American journal of managed care
JID - 9613960
RN  - 0 (Biomarkers)
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Asthma/*drug therapy/*physiopathology
MH  - *Biomarkers
MH  - Cohort Studies
MH  - *Databases as Topic
MH  - Female
MH  - Humans
MH  - Male
MH  - *Managed Care Programs
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Young Adult
EDAT- 2010/05/18 06:00
MHDA- 2010/08/19 06:00
CRDT- 2010/05/18 06:00
PHST- 2010/05/18 06:00 [entrez]
PHST- 2010/05/18 06:00 [pubmed]
PHST- 2010/08/19 06:00 [medline]
AID - 12636 [pii]
PST - ppublish
SO  - Am J Manag Care. 2010 May;16(5):327-33.