How well do the HEDIS asthma inclusion criteria identify persistent asthma?
OBJECTIVE
(1) To determine if the Health Plan Employer Data and Information Set (HEDIS) asthma inclusion criteria consistently identify persistent asthma on a year-to-year basis and (2) to explore whether variation in the number of years of qualification is associated with medication and resource utilization outcomes.


METHODS
Retrospective observational study.


METHODS
We identified 132 414 patients in a large healthcare program who were included in 1 or more HEDIS persistent asthma cohorts between 1999 and 2002 and who had continuous insurance and pharmacy benefit coverage for the entire 4-year observation period. Medication, emergency department, and hospital use in 2002 was identified using electronic claims and pharmacy information.


RESULTS
Overall, 47.9% of the patients were identified as having persistent asthma in only 1 of 4 years, 40.8% had at least 2 consecutive years, and 28.2% had at least 3 consecutive years. In bivariate and multivariate analyses, more consecutive years of HEDIS persistent asthma qualification significantly increased the likelihood of frequent short-acting b-agonist use, inhaled antiinflammatory corticosteroid use, at least 1 emergency department visit, and at least 1 hospitalization. The strongest relationship was for 3 or more consecutive years of HEDIS qualification.


CONCLUSIONS
A significant portion of the HEDIS persistent asthma cohort does not qualify on a year-to-year basis, suggesting that the current 1-year qualification period or the underlying administrative case definition for persistent asthma may be suboptimal. Further clinical validation studies are needed to determine the optimal criteria for a more useful HEDIS persistent asthma case definition.
Mosen
David M
DM
Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR 97232, USA. david.m.mosen@kpchr.org
Macy
Eric
E
Schatz
Michael
M
Mendoza
Guillermo
G
Stibolt
Thomas B
TB
McGaw
Jeryl
J
Goldstein
Juli
J
Bellows
Jim
J
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D019992:Databases as Topic; D005260:Female; D006264:Health Benefit Plans, Employee; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology