Evaluation of a Pediatric Asthma High-risk Scoring Algorithm

• Published in: The American journal of managed care 2022-06, Vol.28 (6), p.1
• Main Authors: Farber, Harold J, Silveira, Edwin A, Moore, Robert, Sockrider, Marianna M
• Format: Article
• Language: English
• Subjects: Algorithms; Asthma; Children & youth; Childrens health; Emergency medical care; Health risk assessment; Hospitalization; Medicaid; Pediatrics; Risk factors; Steroids
• ISSN: 1088-0224; 1936-2692

Objectives: Identification of patients with asthma at increased risk for hospitalization and emergency department (ED) visits presents opportunity for intervention. Study Design: Retrospective analysis of computerized health plan claims data. Methods: Texas Children's Health Plan, a large Medicaid managed care program, developed an asthma risk scoring algorithm using the clinically relevant parameters of hospitalization for asthma, ED visits for asthma, short-acting β agonist medication dispensing, inhaled corticosteroid medication dispensing, number of prescribing providers, loss to follow-up, and oral corticosteroid dispensing. The risk score performance was evaluated using 2016-2018 risk scores to predict 2017-2019 asthma hospitalizations and ED visits. Results: We identified 107,811 unique members aged 1 to less than 18 years with an asthma diagnosis. For those aged 3 to less than 18 years, the area under the receiver operating characteristic curve (AUC) for risk score predicting hospitalization ranged from 0.72 to 0.79. For those aged 1 to less than 3 years, the AUC ranged from 0.65 to 0.69. Those with a risk score of 1 or greater accounted for 20% to 23% of pediatric members 3 to less than 18 years with asthma but 53% to 56% of asthma hospitalizations in the follow-up year. Sixteen to eighteen percent of those aged 3 to less than 18 years with a risk score of 9 or greater were hospitalized in the follow-up year. Conclusions: Texas Children's Health Plan asthma risk score stratifies risk of asthma hospitalization and ED visits for Medicaid-insured children. The risk score performs better for children aged 3 to less than 18 years than for those aged 1 to less than 3 years.