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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

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

Alexandra E. Shields, Catherine Comstock and Kevin B. Weiss
Pediatrics March 2004, 113 (3) 496-504; DOI: https://doi.org/10.1542/peds.113.3.496
Alexandra E. Shields
*Health Policy Institute, Georgetown Public Policy Institute, Georgetown University, Washington, DC
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Catherine Comstock
*Health Policy Institute, Georgetown Public Policy Institute, Georgetown University, Washington, DC
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Kevin B. Weiss
‡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
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Abstract

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 β-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.

  • racial disparities
  • process of care
  • quality of care
  • Medicaid
  • pediatric asthma
  • guidelines
  • Received February 12, 2003.
  • Accepted June 25, 2003.
  • Copyright © 2004 by the American Academy of Pediatrics

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Pediatrics
Vol. 113, Issue 3
1 Mar 2004
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Variations in Asthma Care by Race/Ethnicity Among Children Enrolled in a State Medicaid Program
Alexandra E. Shields, Catherine Comstock, Kevin B. Weiss
Pediatrics Mar 2004, 113 (3) 496-504; DOI: 10.1542/peds.113.3.496

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Variations in Asthma Care by Race/Ethnicity Among Children Enrolled in a State Medicaid Program
Alexandra E. Shields, Catherine Comstock, Kevin B. Weiss
Pediatrics Mar 2004, 113 (3) 496-504; DOI: 10.1542/peds.113.3.496
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Subjects

  • Pulmonology
    • Pulmonology
    • Asthma
  • Allergy/Immunology
    • Allergy/Immunology

Keywords

  • racial disparities
  • process of care
  • quality of care
  • medicaid
  • pediatric asthma
  • guidelines
  • 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
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