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PEDIATRICS Vol. 113 No. 3 March 2004, pp. 496-504

Variations in Asthma Care by Race/Ethnicity Among Children Enrolled in a State Medicaid Program

Alexandra E. Shields, PhD*, Catherine Comstock, MPH* and Kevin B. Weiss, MD, MPH{ddagger},§

* Health Policy Institute, Georgetown Public Policy Institute, Georgetown University, Washington, DC
{ddagger} Center for Healthcare Studies and Department of Internal Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois
§ Midwest Center for Health Services and Policy Research, Hines Veteran Affairs Medical Center, Hines, Illinois

Objective. To examine differences in the process of care for Medicaid-enrolled white, Hispanic, and black children with asthma.

Design. 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 ß-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.

Key Words: racial disparities • process of care • quality of care • Medicaid • pediatric asthma • guidelines

Abbreviations: ED, emergency department • PCCM, primary care case manager • ADG, ambulatory diagnostic group • NCQA, National Committee for Quality Assurance • NAEPP, National Asthma Education and Prevention Program • ANOVA, analysis of variance • CHC, community health center • OPD, outpatient hospital department • CI, confidence interval • OR, odds ratio

Received for publication Feb 12, 2003; Accepted Jun 25, 2003.




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