title: Correlation of care process measures with childhood asthma exacerbations.
abstract: OBJECTIVE
  We sought to define processes of pediatric asthma care identifiable through administrative data that correlate with asthma exacerbations for use in quality improvement.
  
  
  METHODS
  Commercially insured children aged 5 to 17 years from the Pediatric Physicians' Organization at Children's, an independent practice association affiliated with Boston Children's Hospital, with persistent asthma in 2008, 2009, or 2010 were identified. The correlations of various process measures with asthma exacerbations, defined as hospitalizations or emergency department visits for asthma or outpatient visits for asthma with an oral steroid prescription, were analyzed by using logistic regression.
  
  
  RESULTS
  Significant correlations were found between filling 0 vs ≥ 1 controller medications in all years (relative risk [RR] 3.35, 2.11, and 2.71 in 2008, 2009, and 2010, respectively) although only 4% of subjects overall filled no controller medications. The asthma medication ratio (controller prescriptions divided by total asthma prescriptions) was also associated with exacerbations, with the lowest 2 quartiles having a lower risk compared with the highest in all years (RR 2.27, 2.45, and 2.39 for the lowest; RR 2.10, 2.02, and 2.65 for the second quartile in 2008, 2009, and 2010, respectively).
  
  
  CONCLUSIONS
  Filling 0 vs ≥ 1 controllers and the asthma medication ratio correlated with asthma exacerbations. Although both might serve as quality improvement metrics for pediatric asthma, we favor the asthma medication ratio because it applies to a broader range of children with asthma and better reflects the recommended clinical approach for children with persistent asthma.
authors.affiliation: The Pediatric Physicians' Organization at Children's, Brookline, MA 02445, USA. louis.vernacchio@childrens.harvard.edu
authors.forename: Louis
authors.initials: L
authors.lastname: Vernacchio
authors.forename: Emily K
authors.initials: EK
authors.lastname: Trudell
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Muto
mesh_terms: D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D055656:Prescriptions; D017064:Process Assessment, Health Care / Q000379:methods* / Q000639:trends*
chemical_list: D018927:Anti-Asthmatic Agents