Identifying high-risk asthma with utilization data: a revised HEDIS definition.

OBJECTIVE: To develop a definition of high-risk asthma that more precisely identifies patients needing case management than the 2006 Healthcare Effectiveness Data and Information Set (HEDIS) definition. STUDY
DESIGN: Two-year claims-based study, with cross-sectional phone survey data, for a sample of 769 youths (age 11-17 years) with asthma.
METHODS: The 2006 HEDIS measure defines high-risk asthma as meeting any of the following criteria: >1 emergency department (ED) visits, > or =1 hospitalizations for asthma, > or =4 asthma medication prescriptions, or > or =4 ambulatory visits for asthma with > or =2 prescriptions for asthma medication in 1 year. We created a revised definition (> or =1 ED visits or > or =1 hospitalizations for asthma or > or =1 oral steroid prescriptions for asthma) and identified patients with high-risk asthma in year 1 according to each definition. We compared the 2 groups on demographic and clinical characteristics, and healthcare utilization and costs in years 1 and 2.
RESULTS: The revised definition identified 29% of the sample as having high-risk asthma, whereas the 2006 definition identified 67%. Compared with the 2006 definition, the revised definition identified patients with significantly greater asthma-related physical health problems and higher medical costs in year 1. In year 2, youths classified as high risk by the revised definition made more ED visits and were more likely to use oral steroids than those classified as high risk by the 2006 definition.
CONCLUSION: The revised high-risk asthma definition identifies half as many individuals and is better able to identify patients with poorly controlled asthma in the subsequent year.