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.
Health Policy Institute, Georgetown Public Policy Institute, Georgetown University, Washington, DC 20007, USA. shieldsa@georgetown.edu
Alexandra E
AE
Shields
Catherine
C
Comstock
Kevin B
KB
Weiss
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