Variations in asthma care by race/ethnicity among children enrolled in a state Medicaid program.
OBJECTIVE
To examine differences in the process of care for Medicaid-enrolled white, Hispanic, and black children with asthma.


METHODS
Retrospective cohort study using Medicaid claims data to analyze the process of asthma care in 1994, including all white (non-Hispanic), black (non-Hispanic), and Hispanic children (aged 2-18 years) with asthma in the non-health maintenance organization portion of the Massachusetts Medicaid program (N = 5773). Main outcome measures included performance on 6 claims-based process-of-care measures that reflect national guidelines. Measures addressed primary and specialty care for asthma, appropriate asthma pharmacotherapy, and timely follow-up care after asthma emergency department (ED) visits and hospitalizations.


RESULTS
Controlling for case mix, provider type, disability status, age, and gender, Hispanic children with asthma were 39% less likely than white children to have a specialist visit for asthma (odds ratio [OR]: 0.61; confidence interval [CI]: 0.46-0.81) and 41% less likely to receive a follow-up visit within 5 days of being seen in the ED for asthma (OR: 0.59; CI: 0.36-0.95). However, Hispanic children received better care in 2 respects. They were 16% more likely than white children to receive a minimum of 2 asthma visits per year (CI: 1.01-1.34) and 27% less likely to be overprescribed beta-agonist medications (OR: 0.73; CI: 0.54-0.99). Black children were 64% less likely than white children to receive timely follow-up care after being seen in the ED for asthma (OR: 0.36; CI: 0.18-0.73). There were no racial/ethnic differences in the prescribing of antiinflammatory medications or timely follow-up care after an asthma hospitalization.


CONCLUSIONS
This study demonstrates important differences in the process of care experienced by racial/ethnic subpopulations within a Medicaid population, which may help explain differential outcomes. Efforts to improve asthma outcomes should target specific areas in which black and Hispanic children may be receiving suboptimal care.
Shields
Alexandra E
AE
Health Policy Institute, Georgetown Public Policy Institute, Georgetown University, Washington, DC 20007, USA. shieldsa@georgetown.edu
Comstock
Catherine
C
Weiss
Kevin B
KB
D000293:Adolescent; D001249:Asthma / Q000208:ethnology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D008484:Medicaid; D011787:Quality of Health Care; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States